Linda M. Jenkins

Developing a measure for the appropriateness of prescribing in general practice

Objective: To explore the feasibility of using a broader definition of the appropriateness of prescribing in general practice by developing ways of measuring this broader definition and by identifying possible relationships between different aspects of appropriateness and patient outcomes. Design: A questionnaire study of patients and general practitioners before and after study consultations, supplemented by data collected from patients’ medical records and telephone interviews with patients 1 week later. Setting: General practices in the south of England. Participants: 24 general practitioners and 186 of their consulting patients. Main outcome measures: Unwanted, unnecessary, and pharmacologically inappropriate prescriptions; patients’ adherence. Results: Before the consultation 42% of patients said they wanted or expected a prescription for their main problem. Prescriptions were written in two thirds (65%) of study consultations, and 7% of these had not been wanted or expected beforehand. Doctors recorded that one in five prescriptions they wrote were not strictly indicated. Of the 92 independent assessments of these prescriptions, four were judged to be inappropriate and in 19 cases the assessors were uncertain. 41% of prescriptions written were wanted, necessary, and appropriate. Subsequently, 18% of patients for whom a prescription had been written were potentially non-adherent and 25% had worries or concerns about their medication. Conclusion: The attempt to measure appropriateness of prescribing along the three dimensions of patients’, prescribers’, and pharmacological perspectives is both feasible and likely to yield valuable insights into the nature of general practice prescribing and patients’ use of medicines.

Measuring the appropriateness of prescribing in primary care: are current measures complete?

Background and objectives:  Appropriateness of prescribing is often assessed by standard instruments. We wished to establish whether judgements of appropriateness that included patients’ perspectives and contextual factors could lead to different conclusions when compared with commonly used instruments. To explore the predictive accuracy of these instruments.

Predictors of outcome in patients consulting their general practitioners for headache: A prospective study

Headache is the most common neurological symptom presenting to general practitioners (GPs). Identifying factors predicting outcome in patients consulting their GPs for headache may help GPs with prognosis and choose management strategies which would improve patient care. We followed up a cohort of patients receiving standard medical care, recruited from 18 general practices in the South Thames region of England, approximately 9 months after their initial participation in the study. Of the baseline sample (N = 255), 134 provided both full baseline and follow-up data on measures of interest. We determined associations between patients’ follow-up scores on the Headache Impact Test-6 and baseline characteristics (including headache impact and frequency scores, mood, attributions about psychological/medical causes of their headaches, satisfaction with GP care and illness perceptions). Greater impact and stronger beliefs about the negative consequences of headaches at baseline were the strongest predictors of poor outcome at follow-up.

Evaluating a third sector community service following stroke

Purpose – The purpose of this paper is to evaluate the needs of stroke survivors and the impact of a Life After Stroke service on users, and to explore the effectiveness of a service provided by a third sector organisation working closely with other stroke service provision. Design/methodology/approach – Review of management documents and reports, polling views of 128 service users through a nationally recognised survey designed to assess the service impact, and using interviews and focus groups to gain a deeper understanding of the value and impact of the service from a range of professionals involved with delivering stroke care. Survey response rates were similar to that experienced nationally and the age/gender profile of respondents suggested they were representative. Findings – The service was highly regarded by service users as providing personal, practical and emotional support from people who were knowledgeable and accessible in acute hospitals. From the wider perspective, professionals involved i...

Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

ABSTRACT This paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern.

Service user involvement: Does it leave people standing on the side-lines? 13th World Congress IASSID

Aim: This study investigated the knowledge base of palliative health care professionals working with people with intellectual disabilities who were dying. Method: Focus groups were held with 38 doctors and nurses in 7 specialist palliative care providers in Kent, UK. Areas of discussion included levels of professional experience in the care of people with ID, areas of concern and barriers to care provision. Results: Data showed that involvement of specialist palliative care services for people with intellectual disability is small. Specialists expressed the view that their training and knowledge of this patient group is also low and that this resulted in anxieties as to how to adequately care for this patient group. Conclusions: Specialist palliative care providers have little contact with patients with ID and know little about their specific ID needs. Whilst there may be no obvious discrim- ination against these patients there is a need for greater awareness of ID amongst staff, at all levels, so that the needs of people with ID can be addressed adequately, and appropriately.Aim: Social inclusion is de?ned as having a broad social network and participating in community based activities including paid work. Employment provides independence, empowerment and choice, enabling increased self-esteem and status helping to overcome prejudice and stigma. Government policy in the UK also stresses the importance of the bene?ts of work aiming to end discrimination faced by disabled people. A UK social care organization commissioned the Tizard Centre to compare a social enterprise to day centre provision in relation to social networks from the view point of service users. Method: Semi-structured interviews were held with ?? individuals with intellectual disabilities, ?? of whom worked in the social enterprise, the rest attending day centres across ? areas of a county in South East England. In line with service user involvement, participants were supported to disseminate results. Results: Compared to individuals attending day centres, those working in the social enterprise scored signi?cantly higher on life experience domains, selfesteem and satisfaction levels and differences in knowledge of employment rights were found. However, no differences in social network size or density were recorded. Conclusions: Social enterprises are better training grounds for future employment compared to day centres but social inclusion is still lacking.