James McEwen

The Nottingham health profile: Subjective health status and medical consultations

Abstract The decision to consult a doctor for medical reasons may be assumed to be indicative of the perception of a health problem by the patient. A study was carried out to compare the scores of consulters and non-consulters of a general practice, on the Nottingham Health Profile, which is designed to be a standardized and simple measure of subjective health status in the physical, social and emotional domains. Data on physical activity, absence from work and overall self-rated health were also collected. Each section of the Profile showed significant differences in score between consulters and non-consulters. Significant associations were also found between scores on the Profile and both self-rated health and absence from work. The association between scores and amount of physical activity was less clear cut. Females had a lower subjective health status than did males on all sections except those reflecting pain and physical mobility problems. The age-group 40–49 had a lower subjective health status than younger and older groups and for this age group males scored higher than females on sections representing emotional, social and sleep problems. The study indicates that the Nottingham Health Profile is a valid and sensitive measure of subjective health, which may well be a better predictor of need for and utilization of health services than “hard” data such as mortality and morbidity statistics.

Perceived health: age and sex comparisons in a community.

The need to find accurate and reliable indicators on which to base the planning, provision, and evaluation of health services gave impetus to the attempt to develop reliable and valid measures of the perceived health status of the consumers of health care. Subjective measures can provide an important complement to traditional statistics by giving direct access to the personal feelings of discomfort or distress that influence the use of health services. Such measures also give meaningful criteria for the evaluation of the efficacy of such services. Self assessments of health obtained from surveys and interviews have consistently found age and sex differences in the tendency to report symptoms, ill-health, disability, visits to doctors, and sickness absence. Many of these data, however, may have been misleading in using instruments of unknown or uncertain validity and reliability. Nevertheless, subjective assessments of health have been shown to have value and to add a dimension to objective measurements of health. They have been considered to be one of the better predictors of mortality and of adjustment to major episodes of illness.

Subjective health assessments and the perceived outcome of minor surgery

A simple and standardised measure of perceived health status, the Nottingham Health Profile, was used to assess the effect on perceived health status of surgical intervention in a variety of non-acute medical disorders. Patients were assessed a few days before their operation and again two months later and were compared with a control group who had not undergone surgery. Results showed very little change in subjective health from before to after surgical intervention. The experimental group had similar perceived health scores to the control group on the pre- and post-tests. It is suggested that the period allowed to elapse after surgical intervention was too short, or that the level of problems experienced by patients prior to surgery was too low to show significant change. It is also possible that the particular presenting disorders were only one possible somatic representation of general feelings of minor ill-health in the group. The findings of this study point to the need to look at the differences between doctors and patients expectations of the outcome of surgery, the decision to seek care and the factors that govern wellbeing.

What patients bring to occupational health services.

The diversity of practice in occupational health services is well known. This study examines certain aspects of the treatment component of occupational health services in 20 organizations. Considerable variation in contact with these services was shown, mainly accounted for by non-occupational diseases, with less than half of the contacts being due to occupational conditions. The vast majority of the contacts result in the patient returning to work. It is evident that occupational health services can make a valuable and extensive contribution to primary care.

Patterns of illness and use of services in a new town: A preliminary report

This study has examined the consulting patterns of patients in a general practice in a new town. Overall consulting rates and the diagnostic patterns for subsets of this population, with differing degrees of mobility in their life-styles, are compared. The study was restricted to women under 45 years of age and to children, since previous studies had shown higher consulting rates for these categories. The results indicate an overall low utilization of general practitioner services. The more mobile groups did not show a higher rate of consulting, despite their less settled life-style. Over the three years of the study there was a reduction in consultations for minor illnesses and this may be related to the practice policy of encouraging self-care for these conditions. Some of the methodological problems of this type of study are discussed and the difficulties of comparison with other studies are outlined.

The interface between occupational health services and the national health service

A study of 23 occupational health services in the Nottingham area examined the provision of primary care within these services and the relationship with the National Health Service. The analyses were based on 13,500 contacts during a month of observation. There was relatively little contact between occupational health services and the National Health Service. Less than 2% of contacts resulted in referral to hospital and 10% in referral to general practice. Referral rates were higher first thing in the morning and at the beginning of the working week, indicating that many patients preferred to wait and consult the occupational health service before contacting the general practitioner. Only rarely were patients referred to the occupational health service for specific items of treatment. Improved communications might lead to a reduction in the isolation of occupational health services and enable patients to make the most appropriate use of services and facilities.