Showing papers by "Brenda Leese published in 1995"

Change in general practice and its effects on service provision in areas with different socioeconomic characteristics.

Abstract: Objective: To investigate the changes in the structure and service provision of general practice in areas with different socioeconomic characteristics. Design: Interview survey; postal questionnaire. Setting: 260 group and 80 singlehanded general practices in six family health services authorities in England. Main outcome measures: Changes in computer-isation, premises, staffing, incomes, and service provision since the introduction of the 1990 contract, including comparison with data from a study in 1987. Results: In 1993, 94% (245) of group practices were computerised compared with 38% in 1987, and 35% (90) of practices had used the cost rent scheme since 1987. Practice managers were employed in 88% (228) of group practices, and practice nurses in 96% (249) (61% and 60% respectively in 1987). Diabetes and asthma programmes were generally more common in the more affluent areas than elsewhere. A minority of practices (27% (9/33)) in the London inner city area achieved the higher target level for cervical smear testing, compared with 88% (230) overall. A similar trend was apparent for childhood immunisation. Perceived workload increased sharply between 1987 and 1993. Differences in the mean net incomes of general practitioners between areas were much lower than in 1987. Singlehanded practices generally had more problems than group practices in improving service provision. Conclusions: Practices in all areas have shown a strong response to the new incentives. The evidence suggests, however, that generally the urban and inner city practices still lag behind practices in rural and suburban areas in terms of practice structure and service provision.

Family doctors and change in practice strategy since 1986.

Abstract: Objectives: To investigate the changes in practice strategy that have taken place since 1986. Design: Comparison of practices in 1986 and 1992. Setting: 93% of group practices (26 practices) in a single family health services authority. Main outcome measures: Changes in staffing, premises, equipment, clinic services, and incomes between 1986 and 1992. Results: In 1986, 28% of practices employed a nurse; in 1992, 92% did so. Between 1986 and 1992, 14 cost-rent schemes costing more than £10000 had been started. Certain practices, designated innovators, were more likely to possess specified items of equipment than other practices. Computer ownership was widespread: 77% of practices had a computer, compared with 36% in 1986. In 1992, 16 practices had a manager, compared with 10 in 1986. Clinic services provided by more than half of practices were well established services (antenatal, for example), new services for which a payment had been introduced (such as diabetes, asthma, minor surgery), or the more readily provided “new” clinic services (diet, smoking cessation). Gross income increased, but so did practice costs, especially for innovators. Practices in the more affluent area of the family health services authority were still more likely to invest in their premises and staff, and to provide more services than those in the declining area. In the more affluent area, practices had higher costs but also higher incomes. Conclusion: Between 1986 and 1992, practices in this area invested heavily in equipment and services, but differences remain, depending on the location of the practice. Investment has increased, particularly in the more deprived part of the area, so that the inconsistency in standards has been much reduced. Practice incomes have risen, but so also have workload and costs.

Diabetes mellitus and the St Vincent Declaration. The economic implications.

Abstract: Diabetes mellitus imposes significant costs both on individuals and on healthcare delivery systems. Chronic diseases such as diabetes mellitus have lifetime costs, and so resources spent on interventions now may not bring benefits, in terms of reduced complications, for many years.

Local research ethics committees. Differences in application process cause problems.

Abstract: EDITOR,--We wish to contribute to the debate on the role of local research ethics committees.1 2 3 4 Recently, we carried out a pilot study investigating the cost effectiveness of specialist outreach clinics in general practice in two specialties, dermatology and orthopaedic surgery. We sought approval from nine local research ethics committees to approach patients attending outpatient clinics in hospitals and general practice. We asked patients to complete a questionnaire about their health status and experience of attending the clinic and to …

Communication AIDS for the Speech Impaired: Cost and Quality-of-Life Outcomes of Assessment Programs Provided by Speciaiist Communication Aids Centers in the United Kingdom

Abstract: An evaluation was conducted of the approaches, costs, and quality-of-life outcomes associated with communication aid assessment programs for the speech-impaired provided by specialist Communication Aids Centres (CACs) in the United Kingdom. The average costs of CAC assessment programs was £410 per client, which is not excessive. There was evidence of moderate quality-of-life benefits from clients' use of the recommended aids.

A Stitch in Time? Minor Surgery in General Practice. Centre for Health Economics Discussion Paper no. 132

Abstract: This paper describes a study of local evidence from 6 socioeconomically different areas of England about the development of minor surgery in general practice since the 1990 contract. The results are discussed in relation to a review of the literature on minor surgery in general practice. Evidence suggests that general practitioners in the study areas have taken up the minor surgery option with enthusiasm, indicated by the increased activity. Activity does, however, vary by area, with greater service provision being evident in the more affluent areas. Issues of concern remain, especially lack of appropriate skills and expertise, and research into the most effective teaching methods is urgently needed. Issues of quality and effectiveness have still to be addressed. Local audit is necessary to ensure that increased activity leads to improved patient care.

A stitch in time? Minor surgery in general practice

Abstract: This paper describes a study of local evidence from 6 socioeconomically different areas of England about the development of minor surgery in general practice since the 1990 contract. The results are discussed in relation to a review of the literature on minor surgery in general practice. Evidence suggests that general practitioners in the study areas have taken up the minor surgery option with enthusiasm, indicated by the increased activity. Activity does, however, vary by area, with greater service provision being evident in the more affluent areas. Issues of concern remain, especially lack of appropriate skills and expertise, and research into the most effective teaching methods is urgently needed. Issues of quality and effectiveness have still to be addressed. Local audit is necessary to ensure that increased activity leads to improved patient care.

Economic Evaluations of Type II Diabetes

Abstract: Economic analyses, which can be either descriptive or evaluative, can help to ensure that healthcare resources are used effectively. Most studies of diabetes mellitus have been descriptive and have used the cost-of-illness methodology, which estimates the burden of a disease to society. This method provides an estimate of the direct, indirect and intangible costs of a disease or illness. Methodological problems are mainly related to the measurement of indirect costs and even to whether they should be included at all. Existing studies that have measured the direct costs of non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) serve to highlight the difficulties involved in comparing costs between countries with different healthcare systems, and the importance of defining the study population and the sources of the costs. There is a lack of recent data on the costs of treating people who have diabetes.