Health trends最新文献

This cohort study compared the experience of patients seeking treatment for menorrhagia who were referred to National Health Service (NHS) or private clinics. Two-hundred and nine patients in 73 general practices in Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire were recruited by their general practitioners and followed-up with questionnaires at nine months and 18 months after entry to the study. One hundred and fifty patients were referred to NHS clinics and 59 to private clinics; there were no significant differences between the two groups of patients in terms of symptom severity, reason for referral or treatment received. Patients who went to private clinics were more likely to report active participation in decisions about their care (p < 0.05 after adjustment for age and educational status), and were slightly more likely to be satisfied with the care they had received. The treatment decisions made in gynaecological clinics in the NHS and private sector were similar, but the decision-making styles appeared to be different. Private patients were more likely to participate in treatment decisions than NHS patients.

The Department of Health has recently published a register of economic evaluations of health care treatments and programmes, to assist health care decision-makers to assess the value for money from alternative ways of allocating scarce resources. If the register is to be useful, it is important that decision-makers have an appreciation of the methodological quality of the studies contained in the register, and hence the confidence that can be placed in the results. This paper outlines an approach for assessing the methodological quality of economic evaluations, and the result of its application to studies contained in the register. Comments are made about the interpretation of the existing register and the future reporting of economic evaluations.

The issuing of a prescription is central to any doctor-patient interaction. Prescribing variation exists and remains largely unexplained. There is little documented evidence of the effect of patient ethnicity on prescribing patterns. We carried out a secondary analysis of data from the General Household Surveys to examine the association between being given a prescription and patient ethnicity. After modelling, we found that Pakistanis and Indians were significantly more likely to receive a prescription from their general practitioner at a consultation compared to white and West Indian ethnic groups. In addition, consultation rate explained the different prescribing rates among women and men in the white group only. This study raises further questions of the underlying reasons causing these differences which need answering.

A postal questionnaire survey was conducted in 1993 to determine the job satisfaction and current state of health of British-trained pre-registration house officers (PRHOs) working in the West Midlands Regional Health Authority. The questionnaire included parts of the Occupational Stress Indicator looking at job satisfaction, and mental and physical ill-health (as manifestations of stress). Out of 234 eligible PRHOs 182 (78%) returned questionnaires: female PRHOs had significantly higher scores for physical and mental ill-health than male PRHOs; 14.2% of PRHOs had scores for mental ill-health, and 17.6% scores for physical ill-health that were higher than the average reported for patients with psycho-neurotic disorders. The PRHOs had significantly lower scores for all individual aspects of job satisfaction and total job satisfaction, and significantly higher scores for mental and physical ill-health than a comparative group of junior hospital doctors (all grades), and a large group of non-health-care white-collar workers. These results indicate that there is a need to raise awareness of stress and stress-related problems faced by junior doctors, and to provide adequate support.

Junior doctors' knowledge of the content and local implementation of the New Deal for junior doctors was surveyed in one English region. Data were analysed from 254 replies (response rate 60%); a majority (86%) knew that the initiative was intended to reduce their working hours, but detailed knowledge was lacking. Less than half could identify the correct limits on contracted hours for full or partial shift working patterns, while 73% knew that they should not be contracted for more than 72 hours per week for an on-call pattern, the most common and traditional pattern worked. Only 20% knew that hours actually worked should not exceed 56 per week. Only 13 of 114 doctors who believed their posts conformed to the New Deal knew the correct hours limits. Only 11% knew any member of the hospital local implementation group for the New Deal. The results of the survey indicate that junior doctors are not well informed about the details of the New Deal, or its local implementation-four years into the New Deal, this situation needs to be improved, especially as junior doctors are now to be asked to validate the progress of the initiative.

This paper describes a pilot programme of short workshops on the critical appraisal of review articles. The twelve workshops, which ran in various parts of the United Kingdom during 1992 and 1993, lasted either one or two half-days, and consisted of a mixture of large-group sessions and critical appraisal in small groups of a systematic review. The 274 participants came from varied backgrounds, though chiefly in public health and purchasing. The workshops were well received and were oversubscribed. Participants reported that they found them useful and that they raised their awareness of the place of evidence about effectiveness in decision-making. The challenge now is to evaluate the impact of such workshops more rigorously.

The variations in the Health of the Nation (HoN) key areas among ethnic minorities living in England and Wales are examined, based on a national mortality study by country of birth for the latest possible period (1988-1992). It addresses the 10 mortality indicators in the HoN White Paper (covering coronary heart disease [CHD] and stroke, cancers, mental illness and accidents), using age-standardised rates adjusted to the European Standard Population. The findings establish variations in the recent health experience of ethnic minorities born outside England and Wales who are now living in England and Wales. CHD among persons aged under 65 years was highest in those born in the Indian Subcontinent, 55% above the normal rate in England and Wales. Caribbeans, and African groups experienced the lowest rates. Stroke mortality under 65 years-of-age was highest in Bangladeshis, followed by other Commonwealth Africans, and then by Caribbeans. Patterns of cancer deaths also varied, with breast cancer mortality rates being lower in all ethnic groups, and lowest in those born in the Indian Subcontinent. By contrast, lung cancer deaths were higher in Irish men and women; lung cancer mortality among Bangladeshi men was significantly higher than Indians and Pakistanis, being only 15% less than that of the rates in England and Wales. Suicides were lowest in Bangladeshis and Pakistanis and highest among Indians and the Irish. Accidental deaths in children were highest in Pakistanis followed by the Irish, who also experienced higher rates among young persons. It is suggested that the HoN strategy should consider setting appropriate and achievable targets, including ones in new areas of relevance to these groups. The National Health Service purchaser/provider framework should respond to the needs of its populations, including ethnic groups.

A survey among a sample of illicit drug misusers in 1993 indicated under-use of dental services, in spite of a high prevalence of dental problems, whilst a survey of dentists revealed reluctance to treat such patients. Most dentists use additional infection control procedures when they detect 'at-risk' patients, but their screening procedures are unlikely to be effective. Most dentists in the survey would welcome extra training focused on drug misuse.

Results of a year-long prospective audit of all arthroscopies of the knee in one NHS Trust hospital indicate that selective magnetic resonance imaging (MRI) would be cost-effective in up to 40% of patients. However, to achieve such savings, at least 14% of patients who would otherwise need diagnostic arthroscopy would need to be excluded from surgery, the cost of MRI must be low, and the success rate of interpreting the scans should be known.