Anne Morgan

Costs and effectiveness of community postnatal support workers: randomised controlled trial.

Abstract Objectives: To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. Design: Randomised controlled trial with six month follow up. Setting: Recruitment in a university teaching hospital and care provided in womens homes. Participants: 623 postnatal women allocated at random to intervention (311) or control (312) group. Intervention: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. Main outcome measure: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. Results: At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were £635 for the intervention group and £456 for the control group (P=0.001). At six months figures were £815 and £639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. Conclusions: There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.

Health-Related Quality of Life and Cost Impact of Irritable Bowel Syndrome in a UK Primary Care Setting

AbstractObjectives: To identify the impact of irritable bowel syndrome (IBS) on health-related quality of life (HR-QOL), time off work and the utilisation and cost of health services. Design: A case-control study was undertaken matching patients with IBS and controls. Quality-of-life information was collected using the Medical Outcomes Study 36-item Short Form (SF-36) health survey, EuroQOL instrument (EQ-5D) and IBS Quality-of-Life (IBS-QOL) instruments. Data on time off work was also collected. National Health Service (NHS) resource use in primary and secondary care was estimated by review of general practitioner (GP) and hospital records over a 12-month period. Setting: Recruitment was from six GPs’ surgeries in the Trent Region of the United Kingdom. Participants: 161 patients with IBS, as defined by the Rome Criteria I were recruited. These were compared with 213 controls matched for age, sex and social characteristics. Main outcome measures: SF-36 and EQ-5D scores; mean number of days off work; mean NHS costs per person during the 12-month study period. Results: Patients with IBS had considerably lower HR-QOL than controls. They scored worse in all dimensions of the SF-36 and the EQ-5D and they had more time off work. On average patients with IBS cost the NHS £123 (95% confidence interval: £35 to £221, 1999 values) more per year than individuals in the control group (p = 0.04). Conclusions: IBS affects patients through reduced quality of life, more time off work and greater healthcare utilisation than a control group of patients without IBS. The difference in quality of life was pronounced and unusual in that it was influential in every dimension of both the SF-36 and the EQ-5D.

Quantifying patient preferences for out-of-hours primary care.

Objective: To quantify public preferences for different attributes of out-of-hours primary medical care. Methods This study applies a technique called conjoint analysis. A focus group was convened to identify the most important attributes for inclusion in the study, followed by a postal questionnaire asking people to choose between hypothetical services containing different mixes of these attributes. Multi-variate regression analysis estimated the relative importance of different attributes to respondents. The respondents were 436 adults who were among respondents to an earlier postal survey of 25 090 randomly selected Sheffield residents. Results: The doctors manner (whether the doctor takes time to listen), the type of consultation (whether the patient receives a home visit, telephone advice, sees an accident and emergency doctor or attends a primary care treatment centre) and waiting time for consultation best predicted the publics preferences for out-of-hours care. Another three attributes - ease of access; seeing a familiar doctor; and the doctors shift arrangements - were not statistically significant. Conclusions: By asking people to make simple choices between hypothetical services, it is possible to quantify their strength of preference for different aspects of a service. This has important implications for the planning of services. Specifically, for out-of-hours services, more consideration should be given to the doctors manner and waiting times rather than familiarity of doctor.

parents’ experiences of a family literacy programme

Relatively few studies of family literacy programmes have investigated parents’ views, despite their importance for the future development of this kind of programme in early childhood education. This article reports on a family literacy programme from the perspectives of the parents involved in it. The study was carried out in socio-economically disadvantaged communities in a northern English city. Parent experiences were investigated through interviews at the beginning and end of the programme (N = 85) and home visit records. Interviews with a control group (N = 73) of parents who had never participated in a family literacy programme were also conducted at the end of programme. Take-up and participation rates were extremely high for child-focused components of the programme, but the adult (parent-focused) education component had lower take-up. Parents expressed extremely positive views about the child-focused component of the programme and all felt it had benefited children. There was evidence, according to parent report, of programme impact on family literacy practices. Implications for family literacy programmes are discussed.

Coaching as an in‐school leadership development strategy: experiences from Leading from the Middle

There is a large literature on leadership mentoring and coaching. However, in education in England, mentoring is the term that has dominated policy and discussion until recently, with the application of this concept as a core element in teacher training and in the induction of new headteachers. Coaching has emerged more recently as a significant element of continuing professional development for teachers. The first national leadership development programme to embody an explicit and systematic approach to coaching was the National College for School Leadership’s programme for school middle leaders—Leading from the Middle (LftM). This paper explores the experience of school‐based coaching on LftM. It begins by considering key issues concerning the practice of leadership coaching before presenting data on the LftM coaching experience drawn from two evaluations of the programme. The findings suggest that the potential functions of coaches on programmes such as LftM are wider than those in more traditional coaching roles, and the demands arising from the programme and from the school may lead to some role ambiguity. Secondly, three important issues affect the coaching experience: coach skills and commitment, the time devoted to the process, and the place of coaching within broader school leadership development strategies.

Outcomes of In-school Leadership Development Work A Study of Three NCSL Programmes

This article presents the results of a study of the impact of three programmes of the National College for School Leadership (NCSL), namely Leading from the Middle, the National Professional Qualification for Headship and the Leadership Programme for Serving Headteachers. All three programmes embody a blended learning approach that includes an in-school component. This article focuses on factors within the programmes that influence learning from the in-school components. It focuses particularly on factors relating to individual participants and to the school contexts within which they work. The article relates the findings to previous literature on work-based learning and suggests a broader model of the factors that influence the outcomes of leadership development programmes.

Effectiveness and cost-effectiveness of prognostic markers in prostate cancer

This paper demonstrates how economic modelling can be used to derive estimates of the cost-effectiveness of prognostic markers in the management of clinically localised and moderately graded prostate cancer. The model uses a Markov process and is populated using published evidence and local data. The robustness of the results has been tested using sensitivity analysis. Three treatment policies of ‘monitoring’ (observation), radical prostatectomy, or a selection-based management policy using DNA-ploidy as an experimental marker, have been evaluated. Modelling indicates that a policy of managing these tumours utilising experimental markers has an estimated cost per quality-adjusted life year (QALY) of £12 068. Sensitivity analysis shows the results to be relatively sensitive to quality-of-life variables. If novel and experimental markers can achieve specificity in excess of 80%, then a policy of radical surgery for those identified as being at high risk and conservative treatment for the remainder would be both better for patients and cost-effective. The analysis suggests that a radical prostatectomy treatment policy for the moderately graded tumours (Gleason grades 5–7) modelled in this paper may be inferior to a conservative approach in the absence of reliable prognostic markers, being both more costly and yielding fewer QALYs.

Shared Reading Interactions between Mothers and Pre-School Children: Case Studies of Three Dyads from a Disadvantaged Community.

Research has shown that adult-child shared book reading can enhance language and literacy development in the early years, although little is known about how mothers and children from socio-economically disadvantaged communities interact around books. This study investigated the shared reading interactions of three mother-child dyads living in such a community. Mothers were interviewed and videotaped reading at home with their three-year-old children on four separate occasions. The practice of shared reading was found to be common in the homes and mothers felt that reading with their children was important. Videotapes were transcribed and analysed using interpretative methods; this analysis showed substantial differences in the amount and type of interaction for each dyad. Interactions ranged from text focused to participatory. Mothers were tuned to their children’s capabilities and children had developed behaviours that encouraged feedback from their mothers. While many of the behaviours involved simple discussions around illustrations, some sophisticated reading behaviours were also observed.

The children's centre teacher role: developing practice in the private, voluntary and independent sector

This study assessed the impact of the role of the teacher in two childrens centres in England and identified some of the supporting and limiting factors that influenced outcomes. The teachers worked across several settings in the private, voluntary and independent (PVI) sector, with the aim of enhancing early years practice and practitioner confidence. A conceptual framework was devised to model the impact of the teacher role based on Leithwood and Levin (2005). Teachers were found to bring vital professional knowledge and experience to the role and delivered their methods through a range of leadership styles as identified in the literature. Teachers were successful in developing practice and staff confidence in settings; this also impacted positively on outcomes for children. However, success was dependent on a number of moderating factors, including sector‐related factors such as the qualifications of staff. Implications for policy and practice are discussed.