Rhys Williams

Development and importance of health needs assessment

Most doctors are used to assessing the health needs of their individual patients. Through professional training and clinical experience we have developed a systematic approach to this assessment and we use it before we start a treatment that we believe to be effective. Such a systematic approach has often been missing when it comes to assessing the health needs of a local or practice population. The health needs of individual patients coming through the consulting room door may not reflect the wider health needs of the community. If people have a health problem that they believe cannot be helped by the health service, then they will not attend. For example, many people with angina or multiple sclerosis are not known to either their local general practitioner or to a hospital specialist. 1 2 Other groups of patients who may need health care but do not demand it include homeless people and people with chronic mental illness. Distinguishing between individual needs and the wider needs of the community is important in the planning and provision of local health services. If these needs are ignored then there is a danger of a top-down approach to providing health services, which relies too heavily on what a few people perceive to be the needs of the population rather than what they actually are. #### Summary points Health needs assessment is the systematic approach to ensuring that the health service uses its resources to improve the health of the population in the most efficient way It involves epidemiological, qualitative, and comparative methods to describe health problems of a population; identify inequalities in health and access to services; and determine priorities for the most effective use of resources Health needs are those that can benefit from health care or from wider social and environmental changes Successful health needs assessments …

Use of the capture-recapture technique to evaluate the completeness of systematic literature searches

Capture-recapture methods were pioneered in ecology and derive their name from censuses of wildlife in which several animals are captured, marked, released, and subject to recapture. In epidemiology the technique examines the degree of overlap between two (or more) methods of ascertainment and uses a simple formula to estimate the total size of the population. When the number already identified is subtracted from this estimate the number of cases not ascertained by either (or any) of the methods can then be calculated. It has been suggested that studies which attempt to ascertain all cases of a given disease in a population should use this method to estimate the number of missing cases.1 2 There are direct parallels between epidemiological studies which attempt to ascertain all available cases and systematic literature …

Health needs assessment: Epidemiological issues in health needs assessment

This is the second in a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively Series editor: John Wright The first article in this series explained the importance of health needs assessment in the context of planning and delivering health care to populations.1 It mentioned the “epidemiological approach” to health needs assessment—the traditional public health approach of describing need in relation to specific health problems using estimates of the incidence, prevalence, and other surrogates of health impact derived from studies carried out locally or elsewhere. This approach has been be extended to the consideration, alongside these measures, of the ways in which existing services are delivered and the effectiveness and cost effectiveness of interventions intended to meet the needs thus described (fig 1).2 This is a logical extension as there is little point in estimating the burden of ill health (except for determining priorities for future research) if nothing can be done to reduce it. Epidemiology has been defined as “the study of the distribution and determinants of health-related states or events in specific populations and the application of this study to control of health problems.”3 It tends, for the most part, to use the “medical model” of health need, viewing need in terms of the occurrence of specific diseases and health related states rather than client groups. Descriptive epidemiology (as opposed to analytical epidemiology—the investigation of the determinants of health related states or events) describes the occurrence of disease in terms of person, place, and time:

A prospective study of the incidence, prevalence and mortality of multiple sclerosis in Leeds

Objective: To establish the prospective incidence of multiple sclerosis and mortality rates of people with multiple sclerosis in Leeds Health Authority and an updated prevalence of multiple sclerosis on 31 October 1999. Methods A population based prevalence register established on 30 April 1996 was maintained by prospectively registering all new cases of multiple sclerosis, flagging all cases with the National Health Service Central Register for notification of deaths and by registering all new clinical events. General practitioners notified patients with multiple sclerosis moving into or out of the area. Results 136 incident cases were prospectively registered from 30 April 1996 living in Leeds Health Authority (with an estimated resident population of 728 840). 57 deaths were notified. 792 people with multiple sclerosis were identified living in Leeds on 31 October 1999. The mean annual incidence rate for the three-year period 1996–1998 was 6.1/105 (95 % CI: 5.1–7.2). The sex ratio of incident cases was 2.3 to 1 women to men. On 31 October 1999 the prevalence of multiple sclerosis in the Leeds Health Authority was 108.7/105 (95 % CI: 101.2–116.5). This compares with a prevalence of 97.3/105 (95 % CI: 90.3 –104.7) on 30 April 1996. The prevalence of definite and probable multiple sclerosis was 93.3/105 (95 % CI: 86.4–100.6) and of suspected multiple sclerosis was 15.4/105 (95 % CI 12.7 –18.5). Crude annual mortality rates of people with multiple sclerosis for 1997 and 1998 were 1.9/105 (95 % CI: 1.1 to 3.2) and 3.2/105 (95 % CI: 2.0 to 4.7). Multiple sclerosis was noted as the underlying cause of death in 8 (14 %) cases. Conclusion The incidence of multiple sclerosis in the Leeds Health Authority is similar to that in the south of the United Kingdom. The difference in successive prevalence figures is less than that published in other serial studies. Multiple sclerosis was notified as the underlying cause of death in a minority of deaths in people with multiple sclerosis.

Sex differences in the use of asthma drugs: cross sectional study

Objectives: To assess the use of asthma drugs by men and women with asthma and to identify sex specific predictors for the use of oral steroids. Design: Cross sectional study. Setting: Six general practicesin East Anglia. Subjects: 103 men and 134 women aged 20-54 with asthma. Main outcome measures: Self reported use of β agonists, inhaled steroids, and oral steroids. Results: No sex difference was found in use of β agonists or inhaled steroids. However a strong association existed between sex and oral steroid use. 40 (30%) women reported using oral steroids compared with nine (9%) men. Women were more than five times (odds ratio=5.5, 95% confidence interval 2.2 to 13.7) more likely to report use of oral steroids than men after asthma symptoms, age, visits to the general practitioner in previous six months, and time since diagnosis of asthma were controlled for. Women who had visited the general practitioner for asthma one or more times in the previous six months were four times (3.9, 1.6 to 9.5) as likely to report use of oral steroids. In addition, more frequent visits to the general practitioner for asthma were related in a dose-response manner to a greater likelihood of using oral steroids among women after asthma symptoms, age, and time since diagnosis were controlled for. This relation was not observed among men. Conclusion: Women used oral steroids more than men. The more frequent consultations with a doctor by women may result in more requests for oral steroids or doctors may preferentially prescribe oral steroids to women.

Assessing progression and efficacy of treatment for diabetic retinopathy following the proliferative pathway to blindness: Implication for diabetic retinopathy screening in Taiwan

Aims The natural history and treatment efficacy of diabetic retinopathy (DR) play important roles in the evaluation of screening. Therefore, the natural history of DR and rates of transition after treatment (including metabolic control and laser photocoagulation) from no diabetic retinopathy (NDR) to blindness were quantified.

Association of British Clinical Diabetologists (ABCD) survey of secondary care services for diabetes in the UK, 2000. 1. Methods and major findings

Objective To examine the provision, and variations in, secondary care diabetes services in the UK.