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11.
Social and Economic Impacts of School Influenza Outbreaks in England: Survey of Caregivers 下载免费PDF全文
12.
Association Between Quality of Primary Care and Hospitalization for Coronary Heart Disease in England: National Cross-sectional Study 下载免费PDF全文
Bottle A Gnani S Saxena S Aylin P Mainous AG Majeed A 《Journal of general internal medicine》2008,23(2):135-141
BACKGROUND A new pay-for-performance scheme for primary care physicians was introduced in England in 2004 as part of an initiative to
link the quality of primary care with physician pay.
OBJECTIVE To investigate the association between the quality of primary care and rates of hospital admissions for coronary heart disease.
DESIGN Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions,
and census data.
PARTICIPANTS All 303 primary care trusts in England, covering approximately 50 million people.
MEASUREMENTS Rates of elective and unplanned hospital admissions for coronary heart disease and rates of coronary angioplasty and coronary
artery bypass grafting were regressed against quality-of-care measures from the Quality and Outcomes Framework, area socioeconomic
scores, and disease prevalence.
RESULTS Correlations between prevalence, area socioeconomic scores, and admission rates were generally weak. The strongest relations
were seen between area socioeconomic scores and elective and unplanned hospital admissions and revascularization procedures
among the age group 45–74 years. Among those aged 75 years and over, the only positive association observed was between area
socioeconomic scores and unplanned hospital admissions.
CONCLUSIONS The lack of an association between quality scores and admission rates suggests that improving the quality of primary care
may not reduce demands on the hospital sector and that other factors are much better predictors of hospitalization for coronary
heart disease. 相似文献
13.
14.
Women's perspectives on human papillomavirus self‐sampling in the context of the UK cervical screening programme 下载免费PDF全文
15.
Mark J. Harrison BSc MSc PhD Linda M. Davies BSc MSc Nick J. Bansback BSc MSc Melanie J. McCoy BSc Tracey M. Farragher BSc MSc PhD Suzanne M. M. Verstappen MSc PhD Andrew Hassell MD MMedEd FRCP Deborah P. M. Symmons MD FFPH FRCP 《Value in health》2009,12(6):1026-1034
Objective: Using inflammatory arthritis patients as an example, we investigate EuroQol-5D (EQ-5D) profiles resulting in states worse than death (WTD), and the heath status of patients occupying these states.
Methods: Baseline data from two UK trials were used that reflected the range of arthritis states/severity found in routine practice. EQ-5D profiles resulting in negative valuations (i.e., states WTD) based on UK weights were identified. EQ-5D scores for these profiles from alternative valuation sets, including a reanalysis of the UK weights, were compared. The health status and characteristics of patients, and factors associated with patients in the low distribution of the EQ-5D and those with WTD EQ-5D scores were identified.
Results: Seven hundred patients were included in the analysis. Sixty-two (9%) patients occupied states WTD. Patients occupied 9 of the possible 84health profiles with negative scores (53% occupied one profile); this profile was not rated WTD by any of the alternative EQ-5D scoring algorithms. All WTD profiles included severe pain/discomfort plus moderate problems in ≥3 other domains. Patients with WTD valuations reported higher levels of pain, and feeling downhearted and low on alternative health status measures.
Conclusions: Pain was the predominant factor in the WTD EQ-5D profiles occupied by arthritis patients. Patients occupying states WTD have poorer health-related quality of life than patients in low "better than death" states. Valuations of profiles vary according to how sets of preference weights for health profiles were developed. Further research should explore whether WTD valuations are supported by qualitative evidence and reflect the patient's health and experience of disease. 相似文献
Methods: Baseline data from two UK trials were used that reflected the range of arthritis states/severity found in routine practice. EQ-5D profiles resulting in negative valuations (i.e., states WTD) based on UK weights were identified. EQ-5D scores for these profiles from alternative valuation sets, including a reanalysis of the UK weights, were compared. The health status and characteristics of patients, and factors associated with patients in the low distribution of the EQ-5D and those with WTD EQ-5D scores were identified.
Results: Seven hundred patients were included in the analysis. Sixty-two (9%) patients occupied states WTD. Patients occupied 9 of the possible 84health profiles with negative scores (53% occupied one profile); this profile was not rated WTD by any of the alternative EQ-5D scoring algorithms. All WTD profiles included severe pain/discomfort plus moderate problems in ≥3 other domains. Patients with WTD valuations reported higher levels of pain, and feeling downhearted and low on alternative health status measures.
Conclusions: Pain was the predominant factor in the WTD EQ-5D profiles occupied by arthritis patients. Patients occupying states WTD have poorer health-related quality of life than patients in low "better than death" states. Valuations of profiles vary according to how sets of preference weights for health profiles were developed. Further research should explore whether WTD valuations are supported by qualitative evidence and reflect the patient's health and experience of disease. 相似文献
16.
Influences on individuals’ decisions to take up the offer of a health check: a qualitative study 下载免费PDF全文
17.
Robin Z. Hayeems PhD Fiona A. Miller PhD Yvonne Bombard PhD Denise Avard PhD June Carroll MD Brenda Wilson MBChB MSc MRCP FFPH Julian Little PhD Pranesh Chakraborty MD Jessica Bytautas BA Yves Giguere MD PhD Judith Allanson MD Renata Axler MBioethics 《Health expectations》2015,18(3):419-429
Objectives
Newborn bloodspot screening (NBS) panels have expanded to include conditions for which treatment effects are less certain, creating debate about population‐based screening criteria. We investigated Canadian public expectations and values regarding the types of conditions that should be included in NBS and whether parents should provide consent.Methods
Eight focus groups (FG; n = 60) included education, deliberative discussion and pre‐/post‐questionnaires. Data were analysed quantitatively and qualitatively.Results
Quantitatively, the majority supported NBS for serious disorders for which treatment is not available (95–98, 82%). A majority endorsed screening without explicit consent (77–88%) for treatable disorders, but 62% supported unpressured choice for screening for untreatable disorders. Qualitatively, participants valued treatment‐related benefits for infants and informational benefits for families. Concern for anxiety, stigma and unwanted knowledge depended upon disease context and strength of countervailing benefits.Conclusions
Anticipated benefits of expanded infant screening were prioritized over harms, with information provision perceived as a mechanism for mitigating harms and enabling choice. However, we urge caution around the potential for public enthusiasm to foster unlimited uptake of infant screening technologies. 相似文献18.
Adam La Caze BPharm PGDipClinPharm BA PhD Michael P. Kelly PhD FRCP FRCPE FFPH Veli‐Pekka Parkkinen PhD Jon Williamson PhD 《Journal of evaluation in clinical practice》2018,24(5):1166-1176
The role of mechanistic evidence tends to be under‐appreciated in current evidence‐based medicine (EBM), which focusses on clinical studies, tending to restrict attention to randomized controlled studies (RCTs) when they are available. The EBM+ programme seeks to redress this imbalance, by suggesting methods for evaluating mechanistic studies alongside clinical studies. Drug approval is a problematic case for the view that mechanistic evidence should be taken into account, because RCTs are almost always available. Nevertheless, we argue that mechanistic evidence is central to all the key tasks in the drug approval process: in drug discovery and development; assessing pharmaceutical quality; devising dosage regimens; assessing efficacy, harms, external validity, and cost‐effectiveness; evaluating adherence; and extending product licences. We recommend that, when preparing for meetings in which any aspect of drug approval is to be discussed, mechanistic evidence should be systematically analysed and presented to the committee members alongside analyses of clinical studies. 相似文献
19.
Rebecca Whear MSc BSc Jo Thompson‐Coon PhD BSc Kate Boddy MSc MA BSc Helen Papworth MA PGCert BA Julie Frier BM BCh BA MSc MFPH Ken Stein MB ChB MSc MD DipRACOG MRCGP FFPH 《Health expectations》2015,18(1):8-21
Aim/Background
To describe the two‐stage prioritization process being used by the UK National Institute for Health Research''s Collaboration for Leadership in Applied Health Research and Care for the South‐West Peninsula (or PenCLAHRC) – a joint health service and university partnership and reflect on implications for the wider context of priority setting in health‐care research.Method
PenCLAHRC''s process establishes the priorities of Stakeholders including service users across a regional health system for locally relevant health services research and implementation. Health research questions are collected from clinicians, academics and service users in Devon and Cornwall (UK) using a web‐based question formulation tool. There is a two‐stage prioritization process which uses explicit criteria and a wide Stakeholder group, including service users to identify important research questions relevant to the south‐west peninsula locality.Results
To date, a wide variety of health research topics have been prioritized by the PenCLAHRC Stakeholders. The research agenda reflects the interests of academics, clinicians and service users in the local area. Potential challenges to implementation of the process include time constraints, variable quality of questions (including the language of research) and initiating and maintaining engagement in the process. Shared prioritization of local health research needs can be achieved between Stakeholders from a wide range of perspectives.Conclusions
The processes developed have been successful and, with minor changes, will continue to be used during subsequent rounds of prioritization. Engagement of Stakeholders in establishing a research agenda encourages the most relevant health questions to be asked and may improve implementation of research findings and take up by service users. 相似文献20.
Anjori Pasricha BHSc MD Roo T. M. Deinstadt BSc BST David Moher PhD Amanda Killoran PhD FFPH Sean B. Rourke PhD Claire E. Kendall MD CCFP MScPH 《Journal of general internal medicine》2013,28(1):127-135