Analysis of inadequate cervical smears using Shewhart control charts

Background  

Inadequate cervical smears cannot be analysed, can cause distress to women, are a financial burden to the NHS and may lead to further unnecessary procedures being undertaken. Furthermore, the proportion of inadequate smears is known to vary widely amongst providers. This study investigates this variation using Shewhart's theory of variation and control charts, and suggests strategies for addressing this.     

A methodology to estimate the potential to move inpatient to one day surgery

Background  

The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment.     

Cluster of liver cancer and immigration: A geographic analysis of incidence data for Ontario 1998–2002

Background  

Liver cancer is not common in Canada in general; however, clustering of the disease causes a concern. We conducted a spatial analysis to determine the geographic variation of liver cancer and its association with the proportion of immigration in Ontario. Liver cancer incidence data between 1998 and 2002 were obtained from the Ontario Cancer Registry. The Canadian Community Health Survey (CCHS) in 2001 provided information on potential risk factors.     

Annals Journal Club: Frequency and Prioritization of Patient Health Risks from a Structured Health Risk Assessment

PURPOSE

To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices.

METHODS

Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as “at risk” or “healthy” for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices.

RESULTS

On average, patients had 5.8 (SD = 2.12; range, 0–13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important.

CONCLUSIONS

Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.     

The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners

Background  

The number of women working in general practice internationally has been steadily rising. In Scotland there have been concerns that such a change may lead to increased part-time working and subsequently to a fall in available general practice manpower despite an apparently rising overall number of general practitioners. However, there is very little information on the actual hours worked by men and women general practitioners or on the types of work they are undertaking.     

Parent-child interactions and objectively measured child physical activity: a cross-sectional study

Background  

Parents influence their children's behaviors directly through specific parenting practices and indirectly through their parenting style. Some practices such as logistical and emotional support have been shown to be positively associated with child physical activity (PA) levels, while for others (e.g. monitoring) the relationship is not clear. The objectives of this study were to determine the relationship between parent's PA-related practices, general parenting style, and children's PA level.     

Development and validation of the Diabetes Numeracy Test (DNT)

Background

The creation of Local Health Care Cooperatives (LHCCs) in Scotland in 1999 was typical of attempts to encourage voluntary integration and co-operation between health care providers. One of the three stated objectives of their introduction was to tackle inequalities and improve access to care.

Methods

We used administrative data on all general practices in 1999 and 2003 to examine whether LHCCs had any measurable impact on six indicators of practice resources and activity. We compare three groups (participant, non-participant, and ineligible practices) through regression analysis of changes over time in group means and within-group inequality (measured using Gini coefficients). In addition, for participants we measure changes in the variation between and within LHCCs.

Results

Despite having similar registered populations to participants, non-participants had lower levels of resources at the start of the period and this differential widened over time. The changes over time in the activity indicators were similar across the three groups. There was little evidence that inequality between LHCC practices narrowed more than in the other two groups. Practices within LHCCs appear to be become more homogenous while variation increased between LHCCs.

Conclusion

The mixed messages from our examination of resources and activity indicators demonstrates that there are likely to be important lessons to be learned from the brief experiment with LHCCs. Clear objectives that are evaluated using a battery of simple performance indicators may help to ensure demonstrable change in future initiatives to foster integration and co-operation.     

Guidelines; from foe to friend? Comparative interviews with GPs in Norway and Denmark

Background  

GPs follow clinical guidelines to varying degrees across practices, regions and countries, but a review study of GPs' attitudes to guidelines found no systematic variation in attitudes between studies from different countries. However, earlier qualitative studies on this topic are not necessarily comparable. Hence, there is a lack of empirical comparative studies of GP's attitudes to following clinical guidelines. In this study we reproduce a Norwegian focus group study of GPs' general attitudes to national clinical guidelines in Denmark and conduct a comparative analysis of the findings.     

Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

Background  

Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients.     

Inequity in the provision of and access to palliative care for cancer patients. Results from the Italian survey of the dying of cancer (ISDOC)

Background  

The palliative services and programs have been developed with different intensity and modalities in all countries. Several studies have reported that a geographic variation in the availability and provision of palliative care services between and within countries exists, and that a number of vulnerable groups are excluded from these services. This survey estimates the distribution of places of care for Italian cancer patients during the last three months of their lives, the proportion receiving palliative care support at home and in hospital, and the factors associated with the referral to palliative care services.     

Gender and age differences among current smokers in a general population survey

Background  

Evidence suggests a higher proportion of current smokers among female than among male ever smokers at the age above 50. However, little is known about the proportion of current smokers among ever smokers in old age groups with consideration of women in comparison to men from general population samples. The goal was to analyze the proportions of current smokers among female and among male ever smokers including those older than 80.     

Organizational culture,team climate and diabetes care in small office-based practices

Background  

Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices.     

Infant feeding among HIV-positive mothers and the general population mothers: comparison of two cross-sectional surveys in Eastern Uganda

Background  

Infant feeding recommendations for HIV-positive mothers differ from recommendations to mothers of unknown HIV-status. The aim of this study was to compare feeding practices, including breastfeeding, between infants and young children of HIV-positive mothers and infants of mothers in the general population of Uganda.     

Associations among parental feeding styles and children's food intake in families with limited incomes

Background  

Although general parenting styles and restrictive parental feeding practices have been associated with children's weight status, few studies have examined the association between feeding styles and proximal outcomes such as children's food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young children's evening food intake in a multiethnic sample of families in Head Start.     

Cancer screening in a middle-aged general population: factors associated with practices and attitudes

Background  

The aim of this study was to identify factors associated with cancer screening practices and with general attitudes toward cancer screening in a general population.     

Hepatitis and liver disease knowledge and preventive practices among health workers in Mexico: a cross-sectional study

Objectives

To assess the knowledge and preventive practices regarding hepatitis and liver disease among a sample of participants in the Mexican Health Worker Cohort Study.

Methods

The study population consisted of 892 participants from Cuernavaca, Mexico. Demographic characteristics, knowledge about hepatitis B, hepatitis C, and liver disease in general, as well as information about prevention practices were obtained from self-reported questionnaires. Participants were grouped into categories that were created using information about their professional background and patient contact status. Knowledge and prevention practices were compared within these categories.

Results

Inadequate levels of knowledge and preventive practices were found, even within the more highly educated group. Nearly 57 % of the participants had inadequate knowledge about liver disease in general, while 76 and 79 % had inadequate knowledge about Hepatitis B virus (HBV) and Hepatitis C virus (HCV), respectively. For general liver disease, the mean knowledge score increased significantly with education, history of HCV screening, and low alcohol consumption.

Conclusions

Health workers should be better educated about hepatitis and liver disease so they can reduce their own risk and share their knowledge of how to prevent liver disease with patients.

     

Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial

Background  

In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach.     

Utility of electronic patient records in primary care for stroke secondary prevention trials

Background  

This study aimed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records (EPRs) as potential outcome measures. The study also evaluated achievement of recommended standards of care; variation between family practices; and changes in risk factor values from before to after stroke.     

Ethnic inequalities in the treatment and outcome of diabetes in three English Primary Care Trusts

Background

Although the prevalence of diabetes is three to five times higher in UK South Asians than Whites, there are no reports of the extent of ethnicity recording in routine general practice, and few population-based published studies of the association between ethnicity and quality of diabetes care and outcomes. We aimed to determine the association between ethnicity and healthcare factors in an English population.

Methods

Data was obtained in 2002 on all 21,343 diabetic patients registered in 99% of all computerised general practitioner (GP) practices in three NW London Primary Care Trusts (PCTs), covering a total registered population of 720,000. Previously practices had been provided with training, data entry support and feedback. Treatment and outcome measures included drug treatment and blood pressure (BP), total cholesterol and haemoglobin A1c (HbA1c) levels.

Results

Seventy per cent of diabetic patients had a valid ethnicity code. In the relatively older White population, we expected a smaller proportion with a normal BP, but BP differences between the groups were small and suggested poorer control in non-White ethnic groups. There were also significant differences between ethnic groups in the proportions of insulin-treated patients, with a smaller proportion of South Asians – 4.7% compared to 7.1% of Whites – receiving insulin, although the proportion with a satisfactory HbA1c was smaller- 25.6% compared to 37.9%.

Conclusion

Recording the ethnicity of existing primary care patients is feasible, beginning with patients with established diseases such as diabetes. We have shown that the lower proportion of South Asian patients with good diabetes control, and who are receiving insulin, is at least partly due to poorer standards of care in South Asians, although biological and cultural factors could also contribute. This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences, and to consider more intensive management of diabetes and education about the disease in South Asian patients.

     

Response shift effect on gastrointestinal quality of life index after laparoscopic cholecystectomy

Purpose  

Traditional pre- and post-surgery quality of life assessments are inadequate for assessing change in health-related quality of life (HRQoL) after laparoscopic cholecystectomy (LC). This study examined whether a response shift, a change in the internal standards of a patient, occurs in patients who have received LC.