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Lous J, Moth G, Huibers L, Vedsted P, Christensen MB. Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations. BMC FAMILY PRACTICE 2019; 20:36. [PMID: 30808295 PMCID: PMC6390329 DOI: 10.1186/s12875-019-0922-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the most common diagnoses, the provided care, and the parental satisfaction with the general practitioner (GP) led OOH service in a Danish population of children (0-5 years). METHODS We conducted a one-year cross-sectional study based on data for 2363 randomly selected contacts concerning children from a survey on OOH primary care including 21,457 patients in Denmark. For each contact, the GPs completed an electronic pop-up questionnaire in the patient's medical record. Questionnaire items focussed on RFE, health problem severity, diagnosis, provided care, and satisfaction. The parents subsequently received a postal questionnaire. RESULTS The most common RFE was non-specific complaints (40%), followed by respiratory tract symptoms (23%), skin symptoms (9%), and digestive organ symptoms (8%). The most common diagnosis group was respiratory tract diseases (41%), followed by general complaints (19%) and ear diseases (16%). Prescriptions were dispensed for 27% of contacts, and about ¾ were for antibiotics. A total of 12% contacts concerned acute otitis media; antibiotics were prescribed in 70%. A total of 38% of contacts concerned fever, and ¼ got antibiotics. A total of 7.4% were referred for further evaluation. The parental satisfaction was generally high, but 7.0% were dissatisfied. Dissatisfaction was correlated with low prescription rate. CONCLUSION Respiratory tract diseases were the most common diagnoses. The GPs at the OOH primary care service referred children to hospital in 7.4% of the face-to-face consultations, and the provided care was evaluated as non-satisfying by only 7.0% of the parents. Clinical implications of the findings mean room for less prescription of antibiotic to children with ear diseases and a need for research in factors related to dissatisfaction.
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Affiliation(s)
- Jørgen Lous
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Jagtvej 20A, DK-8270, Højbjerg, Denmark.
| | - Grete Moth
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice & section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Collins C, O’Shea MT, Cunniffe J, Finegan P. Health system changes needed to support people consulting general practice out of hours services in Ireland. Int J Ment Health Syst 2018; 12:56. [PMID: 30344620 PMCID: PMC6186104 DOI: 10.1186/s13033-018-0235-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties. AIM To establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral. DESIGN AND SETTING Descriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc). METHODS An anonymous extraction of retrospective data from 1 year of the out of hours' electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care. RESULTS Over a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend. CONCLUSIONS There are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.
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Affiliation(s)
- C. Collins
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
| | - M. T. O’Shea
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
| | | | - P. Finegan
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
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Murphy M, Hollinghurst S, Salisbury C. Patient understanding of two commonly used patient reported outcome measures for primary care: a cognitive interview study. BMC FAMILY PRACTICE 2018; 19:162. [PMID: 30261850 PMCID: PMC6161379 DOI: 10.1186/s12875-018-0850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/17/2018] [Indexed: 01/25/2023]
Abstract
Background Standardised generic patient-reported outcome measures (PROMs) which measure health status are often unresponsive to change in primary care. Alternative formats, which have been used to increase responsiveness, include individualised PROMs (in which respondents specify the outcomes of interest in their own words) and transitional PROMs (in which respondents directly rate change over a period). The objective of this study was to test qualitatively, through cognitive interviews, two PROMs, one using each respective format. Methods The individualised PROM selected was the Measure Yourself Medical Outcomes Profile (MYMOP). The transitional PROM was the Patient Enablement Instrument (PEI). Twenty patients who had recently attended the GP were interviewed while completing the questionnaires. Interview data was analysed using a modification of Tourangeau’s model of cognitive processing: comprehension, response, recall and face validity. Results Patients found the PEI simple to complete, but for some it lacked face validity. The transitional scale was sometimes confused with a status scale and was problematic in situations when the relevant GP appointment was part of a longer episode of care. Some patients reported a high enablement score despite verbally reporting low enablement but high regard for their GP, which suggested hypothesis-guessing. The interpretation of the PEI items was inconsistent between patients. MYMOP was more difficult for patients to complete, but had greater face validity than the PEI. The scale used was open to response-shift: some patients suggested they would recalibrate their definition of the scale endpoints as their illness and expectations changed. Conclusions The study provides information for both users of PEI/MYMOP and developers of individualised and transitional questionnaires. Users should heed the recommendation that MYMOP should be interview-administered, and this is likely to apply to other individualised scales. The PEI is open to hypothesis-guessing and may lack face-validity for a longer episode of care (e.g. in patients with chronic conditions). Developers should be cognisant that transitional scales can be inconsistently completed: some patients forget during completion that they are measuring change from baseline. Although generic questionnaires require the content to be more general than do disease-specific questionnaires, developers should avoid questions which allow broad and varied interpretations. Electronic supplementary material The online version of this article (10.1186/s12875-018-0850-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mairead Murphy
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Primary Care Outcomes Questionnaire: psychometric testing of a new instrument. Br J Gen Pract 2018; 68:e433-e440. [PMID: 29581130 PMCID: PMC6001981 DOI: 10.3399/bjgp18x695765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/08/2017] [Indexed: 11/15/2022] Open
Abstract
Background Patients attend primary care for many reasons and to achieve a range of possible outcomes. There is currently no Patient Reported Outcome Measure (PROM) designed to capture these diverse outcomes, and trials of interventions in primary care may thus fail to detect beneficial effects. Aim This study describes the psychometric testing of the Primary Care Outcomes Questionnaire (PCOQ), which was designed to capture a broad range of outcomes relevant to primary care. Design and setting Questionnaires were administered in primary care in South West England. Method Patients completed the PCOQ in GP waiting rooms before a consultation, and a second questionnaire, including the PCOQ and seven comparator PROMs, after 1 week. Psychometric testing included exploratory factor analysis on the PCOQ, internal consistency, correlation coefficients between domain scores and comparator measures, and repeated measures effect sizes indicating change across 1 week. Results In total, 602 patients completed the PCOQ at baseline, and 264 (44%) returned the follow-up questionnaire. Exploratory factor analysis suggested four dimensions underlying the PCOQ items: health and wellbeing, health knowledge and self-care, confidence in health provision, and confidence in health plan. Each dimension was internally consistent and correlated as expected with comparator PROMs, providing evidence of construct validity. Patients reporting an improvement in their main problem exhibited small to moderate improvements in relevant domain scores on the PCOQ. Conclusion The PCOQ was acceptable, feasible, showed strong psychometric properties, and was responsive to change. It is a promising new tool for assessment of outcomes of primary care interventions from a patient perspective.
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Murphy M, Hollinghurst S, Salisbury C. Qualitative assessment of the primary care outcomes questionnaire: a cognitive interview study. BMC Health Serv Res 2018; 18:79. [PMID: 29391003 PMCID: PMC5796473 DOI: 10.1186/s12913-018-2867-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 01/21/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Primary Care Outcomes Questionnaire (PCOQ) is a new patient-reported outcome measure designed specifically for primary care. This paper describes the developmental process of improving the item quality and testing the face validity of the PCOQ through cognitive interviews with primary care patients. METHODS Two formats of the PCOQ were developed and assessed: the PCOQ-Status (which has an adjectival scale) and the PCOQ-Change (which has the same items as the PCOQ-Status, but a transitional scale). Three rounds of cognitive interviews were held with twenty patients from four health centres in Bristol. Patients seeking healthcare were recruited directly by their GP or practice nurse, and others not currently seeking healthcare were recruited from patient participation groups. An adjusted form of Tourangeau's model of cognitive processing was used to identify problems. This contained four categories: general comprehension, temporal comprehension, decision process, and response process. The resultant pattern of problems was used to assess whether the items and scales were working as intended, and to make improvements to the questionnaires. RESULTS The problems identified in the PCOQ-Status reduced from 41 in round one to seven in round three. It was noted that the PCOQ-Status seemed to be capturing a subjective view of health which might not vary with age or long-term conditions. However, as it is designed to be evaluative (measuring change over time) as opposed to discriminative (measuring change between different groups of people), this does not present a problem for validity. The PCOQ-Status was both understood by patients and was face valid. The PCOQ-Change had less face validity, and was misunderstood by three out of six patients in round 1. It was not taken forward after this round. CONCLUSIONS The cognitive interviews successfully contributed to the development of the PCOQ. Through this study, the PCOQ-Status was found to be well understood by patients, and it was possible to improve comprehension through each round of interviews. The PCOQ-Change was poorly understood and, given that this corroborates existing research, this may call into question the use of transitional questionnaires generally.
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Affiliation(s)
- Mairead Murphy
- University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Sandra Hollinghurst
- University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Chris Salisbury
- University of Bristol, Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Murphy M, Hollinghurst S, Salisbury C. Agreeing the content of a patient-reported outcome measure for primary care: a Delphi consensus study. Health Expect 2016; 20:335-348. [PMID: 27123987 PMCID: PMC5354062 DOI: 10.1111/hex.12462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As the first contact for any health-related need, primary care clinicians often address multiple patient problems, with a range of possible outcomes. There is currently no patient-reported outcome measure (PROM) which covers this range of outcomes. Therefore, many research studies into primary care services use PROMs that do not capture the full impact of these services. OBJECTIVE The study aim was to identify outcomes sought by primary care patients which clinicians can influence, thus providing the basis for a new primary care PROM. METHODS We used a Delphi process starting with an outcomes list inductively derived in a prior qualitative study. Thirty-five experts were recruited into patient, clinician and academic panels. Participants rated each outcome on whether it was (i) relevant to health, (ii) influenced by primary care and (iii) detectable by patients. In each round, outcomes which passed/failed preset levels of agreement were accepted/rejected. Remaining outcomes continued to the next round. RESULTS The process resulted in a set of outcomes occupying the domains of health status, health empowerment (internal and external), and health perceptions. Twenty-six of 36 outcomes were accepted for inclusion in a PROM. Primary care having insufficient influence was the main reason for exclusion. CONCLUSIONS To our knowledge, this is the first time PROM outcomes have been agreed through criteria which explicitly exclude outcomes less relevant to health, uninfluenced by primary care or undetected by patients. The PROM in development covers a unique set of outcomes and offers an opportunity for enhanced research into primary care.
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Affiliation(s)
- Mairead Murphy
- Centre for Academic Primary Care, School for Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School for Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, School for Social and Community Medicine, University of Bristol, Bristol, UK
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Murphy M, Hollinghurst S, Turner K, Salisbury C. Patient and practitioners' views on the most important outcomes arising from primary care consultations: a qualitative study. BMC FAMILY PRACTICE 2015; 16:108. [PMID: 26297232 PMCID: PMC4546201 DOI: 10.1186/s12875-015-0323-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/13/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary care clinicians often address multiple patient problems, with a range of possible outcomes. There is currently no patient-reported outcome measure (PROM) which covers this range of outcomes. Consequently, many researchers use PROMs that do not capture the full impact of primary care services. In order to identify what outcomes a PROM for primary care would need to include, we conducted interviews with patients and practitioners. This paper reports these patient and practitioners' views on the outcomes arising from primary care consultations. METHODS Semi-structured interviews were held with 30 patients and eight clinicians across five sites in Bristol. Interviews were audio-recorded, transcribed and analysed thematically. We used a broad definition of health outcome as 'the impacts of healthcare on health, or a patient's ability to impact health' to identify outcomes through this process. RESULTS 10 outcome groups were identified. These occupied 3 domains: Health Empowerment: These are the internal and external resources which enable patients to improve their health. This involves 1) patients' understanding of their illnesses, 2) ability to self-care and stay healthy, 3) agreeing and adhering to a patient-clinician shared plan, 4) confidence in seeking healthcare and 5) access to support. Health Status: This involves 6) reduction of symptoms and 7) reducing the impact of symptoms on patients' lives. Health Perceptions: This involves 8) patients' satisfaction with their health, 9) health concerns, and 10) confidence in their future health. The structure, organisation and nature of primary care means it can affect all 3 domains. CONCLUSIONS No existing PROM captures all these outcomes. For example, many health empowerment PROMs do not consider patient preference on empowerment. Many health status tools are not responsive to changes resulting from primary care. Health perceptions PROMs have generally been designed for measuring personality traits rather than outcomes. This study provides a platform for designing a new PROM containing outcomes that matter to patients and can be influenced by primary care. Such a PROM would greatly enhance the value of primary care research.
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Affiliation(s)
- Mairead Murphy
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Katrina Turner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Abstract
Abstract
The aim of this paper is to review the methodologies employed by health service and pharmacy practice researchers in the evaluation of pharmacy services. The review is in two parts. Part 1 discusses the application of different study designs and frameworks in the evaluation of existing and innovative services and interventions; part 2, to be published in a later issue, will address the methods and measures employed in the evaluation process. The studies included in this review were selected to give examples of different study objectives, designs and frameworks and their application in pharmacy settings. Although many of the issues regarding study design and evaluation frameworks may be relevant to clinical trials comparing the efficacy of alternative drug therapies, the focus of this paper is on pharmacy services.
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Affiliation(s)
- Felicity Smith
- Centre for Pharmacy Practice, School of Pharmacy, University of London, 29/39 Brunswick Square, London, England WC1N 1AX
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Halter M, Marlow T, Mohammed D, Ellison GTH. A patient survey of out-of-hours care provided by Emergency Care Practitioners. BMC Emerg Med 2007; 7:4. [PMID: 17573959 PMCID: PMC1913059 DOI: 10.1186/1471-227x-7-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 06/15/2007] [Indexed: 11/14/2022] Open
Abstract
Background Emergency Care Practitioners (ECPs) have recently been deployed to provide out-of-hours primary care home visits – a practice development that has been supported by policy makers. The aim of the study was to evaluate the care provided to patients receiving out-of-hours home visits from ECPs in London from the patients' perspective and to assess their wellbeing following the visit. Methods A bespoke telephone-administered questionnaire was designed to survey all patients who had received out-of-hours care in Bromley Primary Care Trust from ECPs during a ten week period in 2005 (n = 174). Results Sixty three patients (36.2%) were excluded because: no telephone number was available; they had a diagnosis of dementia; or had not received a study information sheet. The remainder (n = 111) were contacted 3–5 days after the home visit, and 81 of these (73.0%) completed the survey. Of those respondents treated at home who gave unequivocal answers (n = 60), all but one (8.3%) reported that they felt that their treatment had been 'right' and/or had followed any advice given. However, overall only 86.4% reported that they had been clear about their ECP's assessment, and only 58.0% reported that their health was now 'better'. Those who reported that they were not clear about their assessment were less likely to report that their health was 'better' (p = 0.03) and more likely to have subsequently used hospital-based health services (p = 0.03). Conclusion Most patients treated at home by ECPs appeared satisfied and compliant with the care provided, according to the measures used in this study. However, it appears that a sizeable minority of patients were unclear about ECP assessments and it remains to be seen whether these patients had pre-existing health complaints which made them less likely to recover and more likely to seek hospital care, or whether the lack of clarity about their assessment undermined their subsequent recovery and necessitated hospital care. Further research is required to establish if the assessments provided by ECPs are less clear than those provided by other practitioners, and whether it is possible to ensure that all such assessments are clear to all patients. Patients hold a mainly positive view of out-of-hours home visit care provided by ECPs, although a lack of clarity about their assessment was evident, with a possible impact on their continuing health.
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Affiliation(s)
- Mary Halter
- Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, Grosvenor Wing, St George's Hospital, Cranmer Terrace, London SW17 0RE, UK
| | - Tom Marlow
- Community Services Development, 95 Beaconsfield Road, Surbiton, KG5 9AW, UK
| | - Daryl Mohammed
- London Ambulance Service NHS Trust, 8-20 Pocock Street, London, SE1 0BW, UK
| | - George TH Ellison
- Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, Grosvenor Wing, St George's Hospital, Cranmer Terrace, London SW17 0RE, UK
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Farrin A, Russell I, Torgerson D, Underwood M. Differential recruitment in a cluster randomized trial in primary care: the experience of the UK back pain, exercise, active management and manipulation (UK BEAM) feasibility study. Clin Trials 2006; 2:119-24. [PMID: 16279133 DOI: 10.1191/1740774505cn073oa] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cluster randomized trials, which randomize groups of patients rather than individuals, are commonly used to evaluate healthcare interventions such as training programmes targeted at health professionals. This article reports the dangers of randomizing entire primary care practices when participants cannot be identified before randomization, as shown by a UK national trial. METHOD The UK BEAM trial, a national cluster randomized 3 x 2 x 2 factorial trial, was designed to evaluate three treatments for back pain in primary care: "active management"; randomized by practice; and spinal manipulation and exercise classes, both randomized by individual. RESULTS Two hundred and thirty-one participants were recruited in the feasibility study, 165 (141% of expected recruitment) from active (management) practices but only 66 (54% of expected recruitment) from traditional (management) practices. The participants in active practices were significantly different from those in traditional practices, notably in suffering from milder back pain. CONCLUSIONS The feasibility study highlighted the dangers of randomizing clusters when individuals cannot be identified beforehand. Different numbers and types of participants were recruited in the two types of cluster. This differential recruitment led us to change the main trial design by abandoning practice level randomization. Instead all practices were trained in active management to maximize recruitment. Ideally cluster randomized trials should identify patients beforehand, to minimize the chance of selection bias. If this is not possible, patient recruitment should be independent in both intervention and control clusters. Pilot studies are especially important for cluster randomized trials, to identify unforeseen problems.
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Affiliation(s)
- Amanda Farrin
- York Trials Unit, Department of Health Sciences, University of York, Heslington, UK.
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McCaldin M. General practice. J ROY ARMY MED CORPS 2006; 151:199-206. [PMID: 16440965 DOI: 10.1136/jramc-151-03-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M McCaldin
- Principal Ponteland Medical Group, Newcastle-upon-Tyne
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Hurst K. British out‐of‐hours primary and community care: a review of the literature. Int J Health Care Qual Assur 2006; 19:42-59. [PMID: 16548398 DOI: 10.1108/09526860610642591] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This out-of-hours primary and community care services (more recently called unscheduled care) literature review sets out to build on the foundations set by earlier publications by examining old and fresh issues after the new General Medical Service contract was implemented in 2004. DESIGN/METHODOLOGY/APPROACH Almost 140 publications were located, including a range of theoretical and empirical publications. FINDINGS A total of seven themes emerge--varying from the most frequently discussed (service nature and value) to the least examined (information management and technology). ORIGINALITY/VALUE Analysis not only underlines service problems and tensions noted previously but also generates new insights, which cannot be ignored if services are to be developed. Consequently, several recommendations are made.
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Affiliation(s)
- Keith Hurst
- Nuffield Health and Social Care Policy Group, Health Sciences and Public Health Research Institute, Leeds University, UK.
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van Uden CJT, Zwietering PJ, Hobma SO, Ament AJHA, Wesseling G, van Schayck OCP, Crebolder HFJM. Follow-up care by patient's own general practitioner after contact with out-of-hours care. A descriptive study. BMC FAMILY PRACTICE 2005; 6:23. [PMID: 15946382 PMCID: PMC1164410 DOI: 10.1186/1471-2296-6-23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 06/09/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little is known about the care process after patients have contacted a GP cooperative for out-of-hours care. The objective of this study was to determine the proportion of patients who seek follow-up care after contact with a GP cooperative for out-of-hours care, and to gain insight into factors that are related to this follow-up care. METHODS A total of 2805 patients who contacted a GP cooperative for out-of-hours care were sent a questionnaire. They were asked whether they had attended their own GP within a week after their contact with the cooperative, and for what reason. To investigate whether other variables are related to follow-up care, a logistic regression analysis was applied. Variables that entered in this analysis were patient characteristics (age, gender, etc.) and patient opinion on correctness of diagnosis, urgency and severity of the medical complaint. RESULTS The response rate was 42%. In total, 48% of the patients received follow-up care from their own GP. Only 20% were referred or advised to attend their own GP. Others attended because their medical condition worsened or because they were concerned about their complaint. Variables that predicted follow-up care were the patient's opinion on the correctness of the diagnosis, patient's health insurance, and severity of the medical problem. CONCLUSION Almost half of all patients in this study who contacted the GP cooperative for out-of-hours care attended their own GP during office hours within a week, for the same medical complaint. The most important factor that predicted follow-up care from the patient's own GP after an out-of-hours contact was the patient's degree of confidence in the diagnosis established at the GP cooperative. Despite the limited generalisability, this study is a first step in providing insight into the dimension of follow-up care after a patient has contacted the GP cooperative for out-of-hours primary care.
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Affiliation(s)
- Caro JT van Uden
- Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Paul J Zwietering
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Sjoerd O Hobma
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Andre JHA Ament
- Department of Health Organization Policy and Economics, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Geertjan Wesseling
- Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
- Department of Respiratory Diseases, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Onno CP van Schayck
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Harry FJM Crebolder
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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van Uden CJT, Nieman FHM, Voss GBWE, Wesseling G, Winkens RAG, Crebolder HFJM. General practitioners' satisfaction with and attitudes to out-of-hours services. BMC Health Serv Res 2005; 5:27. [PMID: 15801985 PMCID: PMC1079836 DOI: 10.1186/1472-6963-5-27] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 03/31/2005] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives. Methods A GP cooperative separate from the hospital Accident and Emergency (A&E) department, and a GP cooperative integrated within the A&E department of another hospital. Both cooperatives are situated in adjacent geographic regions in the South of the Netherlands. One hundred GPs were interviewed by telephone; fifty GPs working at the separated GP cooperative and fifty GPs from the integrated GP cooperative. Opinions on different aspects of GP cooperatives for out-of-hours care were measured, and regression analysis was performed to investigate if these could be related to GP satisfaction with out-of-hours care organisation. Results GPs from the separated model were more satisfied with the organisation of out-of-hours care than GPs from the integrated model (70 vs. 60 on a scale score from 0 to 100; P = 0.020). Satisfaction about out-of-hours care organisation was related to opinions on workload, guarantee of gatekeeper function, and attitude towards out-of-hours care as being an essential part of general practice. Cooperation with medical specialists was much more appreciated at the integrated model (77 vs. 48; P < 0.001) versus the separated model. Conclusion GPs in this study appear to be generally satisfied with the organisation of GP cooperatives for out-of-hours care. Furthermore, GPs working at the separated cooperative seem to be more satisfied compared to GPs working at the integrated cooperative.
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Affiliation(s)
- Caro JT van Uden
- Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Fred HM Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Gemma BWE Voss
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Geertjan Wesseling
- Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
- Department of Respiratory Diseases, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Ron AG Winkens
- Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Harry FJM Crebolder
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Anderson R, Thomas DW, Phillips CJ. The effectiveness of out-of-hours dental services: II. patient satisfaction. Br Dent J 2005; 198:151-6; discussion 146. [PMID: 15706385 DOI: 10.1038/sj.bdj.4812046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2003] [Accepted: 02/03/2004] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare patients' satisfaction with four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN Postal questionnaire survey of patients who had attended weekend emergency dental services. Patient satisfaction measured using an adapted version of a questionnaire developed for assessing out-of-hours medical services. SETTING Two health authorities in South Wales, UK. SUBJECTS The 411 patients who saw a dentist and completed the patient satisfaction questionnaire. RESULTS The quality of the dentist-patient encounter was similar across services, with most patients being satisfied with the dentist's attitude and manner, the explanations and advice given, and having to see an unfamiliar dentist. Satisfaction was lower, and differed more across services in relation to service accessibility and delays in getting to see a dentist out-of-hours. The walk-in services were perceived as the least accessible: around 40% said they had problems contacting a dentist when the surgery was closed (compared with 16% and 29% in the other two, telephone-access services). Only 12-14% of telephone-access patients said they would be 'happy with advice plus a reliable appointment when surgeries re-opened', whereas almost half of walk-in patients thought this. CONCLUSIONS Despite overall satisfaction with the dentist-patient encounter, there was relative dissatisfaction with the accessibility of all services, especially the walk-in services. Out-of-hours dental services should be better designed to reflect patients' needs: the need for telephone advice as well as face-to-face consultations, and greater awareness that theoretically available services may be difficult to access unless public expectations and awareness are raised.
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Affiliation(s)
- R Anderson
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, PO Box 123, Broadway NSW 2007, Australia.
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Anderson R, Thomas DW, Phillips CJ. The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome. Br Dent J 2005; 198:91-7; discussion 88. [PMID: 15702108 DOI: 10.1038/sj.bdj.4811979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2003] [Accepted: 02/03/2004] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. BASIC DESIGN Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. SETTING Two health authorities in South Wales, UK. SUBJECTS A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. RESULTS For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. CONCLUSIONS Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.
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Affiliation(s)
- R Anderson
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, PO Box 123, Broadway NSW 2007, Australia.
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van Uden CJT, Ament AJHA, Hobma SO, Zwietering PJ, Crebolder HFJM. Patient satisfaction with out-of-hours primary care in the Netherlands. BMC Health Serv Res 2005; 5:6. [PMID: 15651997 PMCID: PMC545962 DOI: 10.1186/1472-6963-5-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 01/15/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years out-of-hours primary care in the Netherlands has changed from practice-based to large-scale cooperatives. The purpose of this study is to determine patient satisfaction with current out-of-hours care organised in general practitioner (GP) cooperatives, and gain insight in factors associated with this satisfaction. METHODS From March to June 2003, 2805 questionnaires were sent to patients within three weeks after they had contacted the GP cooperative in their region. The study was conducted in the province of Limburg in the South of the Netherlands. One-third of these questionnaires was sent to patients who had only received telephone advice, one-third to patients who attended the GP cooperative for consultation, and one-third to patients who received a home visit. Four weeks after the first reminder, a non-respondents telephone interview was performed among a random sample of 100 patients. Analyses were performed with respect to the type of consultation. RESULTS The total response was 42.4% (1160/2733). Sixty-seven percent of patients who received telephone advice only reported to be satisfied with out-of-hours care. About 80% of patients who went to the GP cooperative for consultation or those receiving a home visit, reported to be satisfied. Factors that were strongly associated with overall satisfaction included, the doctor's assistant's attitude on the phone, opinion on GP's treatment, and waiting time. CONCLUSION Patients seem generally satisfied with out-of-hours primary care as organised in GP cooperatives. However, patients who received telephone advice only are less satisfied compared to those who attended the GP cooperative or those who received a home visit.
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Affiliation(s)
- CJT van Uden
- Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - AJHA Ament
- Department of Health Organization Policy and Economics, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - SO Hobma
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - PJ Zwietering
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - HFJM Crebolder
- Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Hannay D. Last night on call; reflection on out-of-hours. Br J Gen Pract 2004; 54:882-3. [PMID: 15635792 PMCID: PMC1324940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
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Abstract
BACKGROUND The reorganized out-of-hours general practitioner (GP) service, resulting in the creation of out-of-hours cooperatives has been widely welcomed by the medical profession. However, GP satisfaction remains only one aspect of this reorganized service and patients' views and levels of satisfaction must have a contribution to make to the organization and delivery of the service. AIM To assess patient satisfaction at two out-of-hours cooperatives in Northern Ireland. METHOD A sample of 4466 patients contacting the out-of-hours service was surveyed by postal questionnaires using a previously validated patient satisfaction instrument. RESULTS Patients who initially requested to be seen at the out-of-hours centre were more likely to receive the contact they requested than those who requested telephone advice or a home visit. Only 41.8% of patients requesting a home visit actually received one. Patients were generally satisfied with the service provided and most satisfied with the 'doctor's manner' and the 'explanation and advice' received. Patients who received the contact they initially requested were more satisfied with all aspects of the service than other patients. The type of contact actually received had little effect on the satisfaction levels reported by patients who received the contact they initially requested. CONCLUSION The population should be made fully aware of the services provided by out-of-hours cooperatives to enable them to have realistic expectations. With realistic expectations, patients are more likely to receive the medical contact they request and consequently will be more satisfied with the service provided. High satisfaction level is an important outcome measure of any out-of-hours service as it increases patient confidence and compliance and ultimately clinical outcome.
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Affiliation(s)
- Kate Thompson
- Centre for Nursing Research, University of Ulster, Coleraine, Northern Ireland.
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Brealey S, Burton K, Coulton S, Farrin A, Garratt A, Harvey E, Letley L, Martin J, Klaber MJ, Russell I, Torgerson D, Underwood M, Vickers M, Whyte K, Williams M. UK Back pain Exercise And Manipulation (UK BEAM) trial--national randomised trial of physical treatments for back pain in primary care: objectives, design and interventions [ISRCTN32683578]. BMC Health Serv Res 2003; 3:16. [PMID: 12892566 PMCID: PMC194218 DOI: 10.1186/1472-6963-3-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2003] [Accepted: 08/01/2003] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low back pain has major health and social implications. Although there have been many randomised controlled trials of manipulation and exercise for the management of low back pain, the role of these two treatments in its routine management remains unclear. A previous trial comparing private chiropractic treatment with National Health Service (NHS) outpatient treatment, which found a benefit from chiropractic treatment, has been criticised because it did not take treatment location into account. There are data to suggest that general exercise programmes may have beneficial effects on low back pain. The UK Medical Research Council (MRC) has funded this major trial of physical treatments for back pain, based in primary care. It aims to establish if, when added to best care in general practice, a defined package of spinal manipulation and a defined programme of exercise classes (Back to Fitness) improve participant-assessed outcomes. Additionally the trial compares outcomes between participants receiving the spinal manipulation in NHS premises and in private premises. DESIGN Randomised controlled trial using a 3 x 2 factorial design. METHODS We sought to randomise 1350 participants with simple low back pain of at least one month's duration. These came from 14 locations across the UK, each with a cluster of 10-15 general practices that were members of the MRC General Practice Research Framework (GPRF). All practices were trained in the active management of low back pain. Participants were randomised to this form of general practice care only, or this general practice care plus manipulation, or this general practice care plus exercise, or this general practice care plus manipulation followed by exercise. Those randomised to manipulation were further randomised to receive treatment in either NHS or private premises. Follow up was by postal questionnaire one, three and 12 months after randomisation. The primary analysis will consider the main treatment effects before interactions between the two treatment packages. Economic analysis will estimate the cost per unit of health utility gained by adding either or both of the treatment packages to general practice care.
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Affiliation(s)
- S Brealey
- Institute of Community Health Sciences, Barts and the London, Queen Mary's School of Medicine and Dentistry, Mile End, London, UK.
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Leibowitz R, Day S, Dunt D. A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction. Fam Pract 2003; 20:311-7. [PMID: 12738701 DOI: 10.1093/fampra/cmg313] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The organization of after-hours primary medical care services is changing in many countries. Increasing demand, economic considerations and changes in doctors' attitudes are fueling these changes. Information for policy makers in this field is needed. However, a comprehensive review of the international literature that compares the effects of one model of after-hours care with another is lacking. OBJECTIVE The aim of this study was to carry out a systematic review of the international literature to determine what evidence exists about the effect of different models of out-of-hours primary medical care service on outcome. METHODS Original studies and systematic reviews written since 1976 on the subject of 'after-hours primary medical care services' were identified. Databases searched were Medline/Premedline, CINAHL, HealthSTAR, Current Contents, Cochrane Reviews, DARE, EBM Reviews and EconLit. For each paper where the optimal design would have been an interventional study, the 'level' of evidence was assessed as described in the National Health and Medical Research Council Handbook. 'Comparative' studies (levels I, II, III and IV pre-/post-test studies) were included in this review. RESULTS Six main models of after-hours primary care services (not mutually exclusive) were identified: practice-based services, deputizing services, emergency departments, co-operatives, primary care centres, and telephone triage and advice services. Outcomes were divided into the following categories: clinical outcomes, medical workload, and patient and GP satisfaction. The results indicate that the introduction of a telephone triage and advice service for after-hours primary medical care may reduce the immediate medical workload. Deputizing services increase immediate medical workload because of the low use of telephone advice and the high home visiting rate. Co-operatives, which use telephone triage and primary care centres and have a low home visiting rate, reduce immediate medical workload. There is little evidence on the effect of different service models on subsequent medical workload apart from the finding that GPs working in emergency departments may reduce the subsequent medical workload. There was very little evidence about the advantages of one service model compared with another in relation to clinical outcome. Studies consistently showed patient dissatisfaction with telephone consultations. CONCLUSIONS The rapid growth in telephone triage and advice services appears to have the advantage of reducing immediate medical workload through the substitution of telephone consultations for in-person consultations, and this has the potential to reduce costs. However, this has to be balanced with the finding of reduced patient satisfaction when in-person consultations are replaced by telephone consultations. These findings should be borne in mind by policy makers deciding on the shape of future services.
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Affiliation(s)
- Ruth Leibowitz
- Department of General Practice, Monash University, Victoria, Australia
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Scott A, Watson MS, Ross S. Eliciting preferences of the community for out of hours care provided by general practitioners: a stated preference discrete choice experiment. Soc Sci Med 2003; 56:803-14. [PMID: 12560013 DOI: 10.1016/s0277-9536(02)00079-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Access to primary care services is a major issue as new models of delivering primary care continue develop in many countries. Major changes to out of hours care provided by general practitioners (GPs) were made in the UK in 1995. These were designed in response to low morale and job dissatisfaction of GPs, rather than in response to patients' preferences. The aim of this study is to elicit the preferences of patients and the community for different models of GP out of hours care. A questionnaire was sent to parents of children in Aberdeen and Glasgow in Scotland who had received a home visit or attended a primary care emergency centre, or were registered with a GP. The questionnaire used a discrete choice experiment that asked parents to imagine their child had respiratory symptoms. Parents were then asked to choose between a series of pairs of scenarios, with each scenario describing a different model of out of hours care. Each model varied by waiting time, who was seen, location, and whether the doctor listened. The response rate was 68% (3,893/5,718). The most important attribute was whether the doctor seemed to listen, suggesting that policies aimed at improving doctor-patient communication will lead to the largest improvements in utility. The most preferred location of care was a hospital accident and emergency department. This suggests that new models of primary care emergency centres may not reduce the demand for accident and emergency visits from this group of patients in urban areas. Preferences also differed across sub-groups of patients. Those who had never used out of hours care before had stronger preferences for waiting time and the doctor listening, suggesting higher expectations of non-users. Further research is required into the demand for out of hours care as new models of care become established.
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Affiliation(s)
- Anthony Scott
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 9ZD, UK.
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Giuffrida A, Gravelle H. Inducing or restraining demand: the market for night visits in primary care. JOURNAL OF HEALTH ECONOMICS 2001; 20:755-779. [PMID: 11558647 DOI: 10.1016/s0167-6296(01)00094-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We analyse the demand for and the supply of night visits in primary care. We present a model of general practitioners (GPs) choice between meeting demand by making visits themselves or passing them to commercial deputising services. We extend previous models of demand management to allow for demand discouragement as well as demand inducement. Demand and supply equations are derived and estimated using 1984/1985-1994/1995 panel data for English primary care health authorities. Demand is not affected by the likelihood that the visit is made by a GP or a deputy, suggesting that patients do not perceive these visits as being of different quality. The introduction of differential fees for GP and deputy visits in April 1990 led GPs to increase their own visits and to reduce the number made by deputies. The fee change also led to demand being managed downward where GPs used deputies and to demand inducement where they met demand themselves.
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Affiliation(s)
- A Giuffrida
- National Primary Care Research and Development Centre, University of York, UK
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O'Reilly D, Stevenson M, McCay C, Jamison J. General practice out-of-hours service, variations in use and equality in access to a doctor: a cross-sectional study. Br J Gen Pract 2001; 51:625-9. [PMID: 11510390 PMCID: PMC1314071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND There is increasing dissatisfaction among general practitioners (GPs) with their 24 hour commitment despite the demand for GP services outside ordinary working hours. The creation of out-of-hours co-operatives has been welcomed by participating GPs and their families and patient satisfaction is generally high. However, there have been concerns about the lack of patient consultation in their development and on the quality of care provided. OBJECTIVES To examine geographical variation in the rates of out-of-hours calls and to see if there is any systematic variation in how the co-operative that covers the area responds to calls. DESIGN OF STUDY A secondary data analysis of 110,357 calls received by the co-operative during the second year of its operation. SETTING A co-operative with four centres providing out-of-hours care for one mostly rural Health Board in Northern Ireland. METHOD Deprivation score and mortality and long-term illness ratios provided indicators of need at an area level. Proximity to the four co-operative centres was measured as the distance in kilometres and estimated travel time (in minutes) along the road network. RESULTS Out-of-hours call ratios were proportional to the area deprivation score and proximity to the co-operative centres, though not to area indicators of ill health. Older patients were more likely to be seen by the GP and females over the age of 15 years were more likely to receive telephone advice only (adjusted odds ratio [OR] = 0.785, 95% confidence intervals [CI] 0.756-0.816, P < 0.001). Each kilometre from the centres reduced the likelihood of seeing the GP (OR = 0.978, 95% CI = 0.976-0.979, P < 0.001). Even after controlling for potential confounders a large difference remained in how centres responded to calls. CONCLUSIONS It is not certain whether these inequalities in services delivery represent inequity as the apposite level or type of response cannot be determined until more is known about the appropriateness of the demand for out-of-hours medical care.
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Affiliation(s)
- D O'Reilly
- Health and Social Care Research Unit, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ.
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Smith S, Lynch J, O'Doherty K, Bury G. Patients' views on out-of-hours care in general practice in Dublin. Ir J Med Sci 2001; 170:192-4. [PMID: 12120974 DOI: 10.1007/bf03173889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known regarding patients' views and levels of satisfaction with out-of-hours care in Irish general practice despite significant recent changes in service delivery. AIMS This study aimed to record patients' experience of out-of-hours care on a specific occasion and elicit their satisfaction with out-of-hours care in general. METHODS Patients requesting out-of-hours care in three south inner city Dublin practices in June and July 2000 were identified and sent an anonymous postal questionnaire. RESULTS Two hundred and forty patients were identified and 58% responded to the questionnaire. The approximate call rate was 195 calls per 1,000 patients per year. Sixty-one per cent of patients used the co-operative service, 28% received a house call and 3% received telephone advice only; 86% are currently satisfied with out-of-hours care. CONCLUSIONS The majority of patients are satisfied with the current out-of-hours service. Telephone consultation rates are significantly lower than other countries. These findings need to be considered before the widespread introduction of systems involving increased telephone consultations.
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Affiliation(s)
- S Smith
- Department of General Practice, University College Dublin, Rialto Medical Centre, Ireland.
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Abstract
OBJECTIVES To describe the relationship between patient satisfaction with out of hours care provided by deputising and practice doctors in four urban areas in England and characteristics of the service provided and patients, the care given, and health outcomes. SETTING -Fourteen general practices in four urban areas in England. PARTICIPANTS People who requested out of hours care. DESIGN Analysis of data from a study of out of hours care. Patients were interviewed within 5 days of their request for out of hours care. Data on the service provided were obtained from medical records and all other data were collected at interview. Satisfaction was measured using a valid reliable instrument. RESULTS 2152 patients were recruited to the study and 1466 were interviewed. Satisfaction data were available on 1402 patients. "Overall satisfaction" was associated with age, doctor type, lack of access to a car at the time of the request, and health outcome. The relationships between satisfaction subscales and patient characteristics (age, sex, ethnicity, and access to a car at the time of the request), service characteristics (doctor type and delay between the request and visit), whether a prescription was given, and health outcome were variable. If an expected home visit was not received, "overall satisfaction" and satisfaction with "communication and management", "doctor's attitude", and "initial contact person" were reduced. CONCLUSION Patient satisfaction is dependent on many factors. Mismatch between patient expectation and the service received is related to decreased satisfaction. This may increase as general practitioners delegate more out of hours care to cooperatives and deputising services.
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Affiliation(s)
- R K McKinley
- Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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Venning P, Durie A, Roland M, Roberts C, Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1048-53. [PMID: 10764367 PMCID: PMC27348 DOI: 10.1136/bmj.320.7241.1048] [Citation(s) in RCA: 309] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care. DESIGN Multicentre randomised controlled trial of patients requesting an appointment the same day. SETTING 20 general practices in England and Wales. PARTICIPANTS 1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations). MAIN OUTCOME MEASURES Consultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs. RESULTS Nurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4. 20, 95% confidence interval 2.98 to 5.41), and nurses carried out more tests (8.7% v 5.6% of patients; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37. 2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner 18.ll pound sterling v general practitioner 20.70 pound sterling adjusted difference 2.33 pound sterling - 1.62 pound sterling to 6.28 pound sterling). CONCLUSIONS The clinical care an health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.
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Affiliation(s)
- P Venning
- University of Manchester School of Primary Care, Rusholme Health Centre, Manchester M14 5NP.
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Nicholl J, Munro J. Systems for emergency care. Integrating the components is the challenge. BMJ (CLINICAL RESEARCH ED.) 2000; 320:955-6. [PMID: 10753131 PMCID: PMC1117896 DOI: 10.1136/bmj.320.7240.955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Methodological work on randomized trials has largely concerned pharmacological interventions in which the effects of the attending health professional may be regarded as minor. In other clinical settings, such as surgery, talk or physical therapies, staff specific variation may make generalization problematic, undermining the value of the trial. Such variation has been the basis of some objections to controlled trial methodology and non-acceptance of trial results. The implication of this source of variation will be considered for studies in which different types of health professional deliver the intervention in each arm of the trial. Such a trial may involve individual patient or group randomization. Whichever method is used, it is argued that variation in outcome between health professionals may lead to design effects. These issues will be illustrated using data from a large trial comparing primary care service delivered by two types of medical doctor. Random effect models are most suitable for analyzing this type of trial, as they allow adjustment for patient characteristics whilst controlling for design effects. This type of model illustrates that there can be substantial variation in the performance within each category of doctor.
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Affiliation(s)
- C Roberts
- Health Care Trials Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Manchester M13 9PT, U.K.
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Roland M, Torgerson D. Understanding controlled trials: what outcomes should be measured? BMJ (CLINICAL RESEARCH ED.) 1998; 317:1075. [PMID: 9774302 PMCID: PMC1114071 DOI: 10.1136/bmj.317.7165.1075] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M Roland
- National Primary Care Research and Development Centre, University of Manchester, Manchester M13 6PL
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Landgraf JM, Maunsell E, Speechley KN, Bullinger M, Campbell S, Abetz L, Ware JE. Canadian-French, German and UK versions of the Child Health Questionnaire: methodology and preliminary item scaling results. Qual Life Res 1998; 7:433-45. [PMID: 9691723 DOI: 10.1023/a:1008810004694] [Citation(s) in RCA: 272] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Using emerging international guidelines, stringent procedures were used to develop and evaluate Canadian-French, German and UK translations/adaptions of the 50 item, parent-completed Child Health Questionnaire (CHQ-PF50). Multitrait analysis was used to evaluate the convergent and discriminant validity of the hypothesized item sets across countries relative to the results obtained for a representative sample of children in the US. Cronbach's alpha coefficient was used to estimate the internal consistency reliability for each of the health scales. Floor and ceiling effects were also examined. Seventy-nine percent of all the item-scale correlations achieved acceptable internal consistency (0.40 or higher). The tests of the item convergent and discriminant validity were successful at least 87% of the time across all scales and countries. Equal item variance was observed 90% of the time across all countries. The reliability coefficients ranged from a low of 0.43 (parental time impact, Canadian English) to a high of 0.97 (physical functioning index, Canadian French) across all scales (median 0.80). Negligible floor effects were observed across countries. Noteworthy ceiling effects were observed, as expected, for the hypothesized physical scales (mean effect 73%). Conversely, fewer ceiling effects were observed for the psychosocial scales (range 3-17% behaviour-parental emotional impact). The item-scaling results obtained in these pilot studies support the psychometric properties of the American-English CHQ-PF50 and its respective translations.
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Christensen MB, Olesen F. Out of hours service in Denmark: evaluation five years after reform. BMJ (CLINICAL RESEARCH ED.) 1998; 316:1502-5. [PMID: 9582141 PMCID: PMC28553 DOI: 10.1136/bmj.316.7143.1502] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Five years after its introduction, to evaluate the 1992 reform in the out of hours service in Denmark. DESIGN Comparison of data before and after reform. Data were collected from published reports, Danish national health statistics, and the Danish trade union for general practitioners. SETTING Denmark. MAIN OUTCOME MEASURES Number of out of hours services; workload of general practitioners; cost of the service; patient satisfaction. RESULTS Five years after the reform, the percentage of telephone consultations had almost doubled, to 48%. Consultations in doctors' surgeries were relatively unchanged, but home visits were much reduced, to 18%. The percentage of doctors who worked 5 hours or more out of hours per week dropped from about 70% to about 50%. Overall patient satisfaction in 1995 was high (72%). CONCLUSION The organisation of the out of hours service, with a fully trained general practitioner in a telephone triage function, is working satisfactorily. Many calls that previously would have required home visits are now dealt with by telephone or through consultations. The out of hours workload for general practitioners has decreased considerably.
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Affiliation(s)
- M B Christensen
- Research Unit for General Practice, University of Aarhus, 2 DK-8000 Aarhus C, Denmark.
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Campbell J. Appropriate Care Out-Of-Hours. Eur J Gen Pract 1998. [DOI: 10.3109/13814789809160792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pencheon D, Lambert M, Hadridge P. So many unanswered questions: the emergency care system of the future. J Accid Emerg Med 1998; 15:49-53. [PMID: 9475224 PMCID: PMC1343009 DOI: 10.1136/emj.15.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- D Pencheon
- Public Health Medicine, Cambridge and Huntingdon Health Authority, UK
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