Liz Smith

What benefits will choice bring to patients? Literature review and assessment of implications:

Objectives To assess the demand for, and likely impact of, increasing patient choice in health care. The study examined whether patients would like to exercise choice of hospital, primary care provider and treatment, and investigated the likely impact of policies designed to increase choice on equity of access, and on the efficiency and quality of service delivery. Method Theory-based literature review including an analysis of the intended and unintended impact of choice-related policies in health care in the UK, European Union and USA. Selected papers focused not only on offering choice to individual patients but also evidence of the impact of choice by patients’ agents such as GPs, and on the impact of introducing choice in education and social services. Results Choosing between hospitals or primary care providers is not currently a high priority for the public, except where local services are poor, e.g. they have long waiting times and where individual patients’ circumstances do not limit their ability to travel. When patients become ill, they are increasingly likely to wish to rely on a trusted health practitioner to choose their treatment. Better educated populations make greater use of information and are more likely to exercise choice in health care. The increase in inequality which this could produce might be reduced by specific provision of information and help, enabling less advantaged populations to make choices about health care. There was little evidence in the literature that providing greater choice will in itself improve efficiency or quality of care. Conclusion Although patients may themselves make limited use of choices, the existence of choice may, in theory, stimulate providers to improve quality of care. Patients do, however, want to be more involved in individual decisions about their own treatment, and generally participate much less in these decisions than they would wish.

The effects of adult aging and induced positive and negative mood on planning

Changes in executive functions have been found in older adults and also in young adults experiencing positive or negative mood states. The current study investigated the hypothesis that older adults would show greater executive function impairment following mood induction than young adults. Ninety-six participants (half aged 19-37, half aged 53-80) completed a neutral, positive, or negative mood induction procedure, followed by the Tower of London planning task. Significant interactions were found between age and mood such that older adults showed greater planning impairment than young adults in both the positive and negative mood conditions. Emotionally salient events occurring before testing may interfere with executive function in older adults.