Showing papers in "Journal of Public Health Medicine in 2001"

A systematic review of discharge coding accuracy.

Abstract: Background The aim of the study was to review systematically the literature measuring the accuracy of routine UK hospital statistics that classify patients on discharge. Methods A systematic review was carried out of studies comparing routine discharge statistics about an episode of hospital care with the original medical record. Dual quality assessment and extraction was completed for included studies. Qualitative and descriptive analyses were undertaken. Additional comparisons of factors that could potentially introduce systematic variation in coding accuracy were also undertaken. Results Thirty studies were identified, of which 21 were included in the review. Twelve of these were conducted in England and Wales, and nine in Scotland. The majority assessed the accuracy of a single diagnosis, or selection of diagnoses in a limited range of hospital settings. The median coding accuracy rates were 91 per cent for diagnostic codes and 69.5 per cent for operation or procedure codes in studies in England or Wales; 82 per cent for diagnostic codes and 98 per cent for operation or procedure codes in Scottish studies. There were no significant differences in coding accuracy over time or in the type or rarity of the codes being assessed. Accuracy rates were higher for ICD7 codes (median 96.5 per cent) than for ICD8 (median 87 per cent) or ICD9 (median 77 per cent). Conclusions Coding accuracy on average is high in the United Kingdom, especially for operations and procedures. However, policy-makers, planners and researchers need to recognize and account for the degree of inaccuracy in routine hospital information statistics. Further research is needed into methods of improving and maintaining coding accuracy.

Effective methods of giving information in cancer: a systematic literature review of randomized controlled trials.

Abstract: There is increasing evidence to suggest that patients with cancer require more information about their disease and its consequences than they receive. In an attempt to address these needs, a variety of methods have been used to facilitate the passage of information from health professionals and other cancer information sources to cancer patients and their families. These include written material, telephone help-lines, teaching and audiovisual aids. Although these efforts have been well received, little attention has been given to the effectiveness of the methods employed. The aims of this paper were to systematically review randomized controlled trials that have evaluated methods of information-giving to cancer patients and their families. Relevant literature was identified through computerized databases, Internet cancer sites and bibliography searches. Multiple reviewers independently analysed the methodological quality of the papers according to agreed criteria. From this process, 10 studies were identified. Interventions ranged from written information to audiotapes, audiovisual aids and interactive medium. Individually tailored methods such as patient care records and patient educational programmes were also reviewed. The evidence indicated that the interventions had positive effects on a number of patient outcomes, such as knowledge and recall, symptom management, satisfaction, preferences, health care utilization and affective states. This was above and beyond the usual care provision. In the majority of studies the interventions had no effect on psychological indices. Furthermore, the review highlighted that certain methods should be based on individual preferences for information rather than uniformly administered.

An assessment of the construct validity of the SF‐12 summary scores across ethnic groups

Abstract: Background The aim of the study was to determine the construct validity of the 12-item Short Form health survey questionnaire (SF-12) across ethnic groups in a large community sample of the United Kingdom. Methods A postal survey was carried out in English using a questionnaire booklet, containing the SF-12 and a number of other items relating to experiences of chronic illness and utilization of health care services. The dataset was the National Survey of NHS Patients. The sample consisted of 1000 residents within each Health Authority in England who were randomly selected from the electoral registers, giving an initial sample of 100 000. Results A total of 61 426 (61.4 per cent) questionnaires were returned; 94.3 per cent of respondents classified themselves as white and 5.7 per cent classified themselves as members of other ethnic groups. Construct validity of the SF-12 was assessed by comparing results from the two summary scores (the Mental Health Component Summary (MCS) score and the Physical Health Component Summary (PCS) score) with overall self-assessed health and limiting longstanding illness. Although there were generally consistent patterns of association between overall self-assessed health or limiting longstanding illness and the MCS and PCS scores in all the ethnic groups, there were significant differences between the MCS and PCS scores of Indians, Pakistanis and Bangladeshis who understood English fluently and those who did not. Furthermore, there were differences in the completion rates of the SF-12 between ethnic groups and a reversal of the general pattern of increasing MCS scores with increasing age in Bangladeshis. Conclusion The results indicate that the use of the SF-12 to measure the health of ethnic minorities seems acceptable in most instances, but may prove problematic in those instances where respondents complete the questionnaire via an untrained translator, such as a friend or family member. The systematic differences in MCS and PCS scores between ethnic minorities who understood English fluently and those who did not suggest that the meaning of specific SF-12 items may change when informally translated. Future research using the SF-12 to measure the health status of ethnic minorities in the United Kingdom via postal surveys must include questions on whether respondents completed the questionnaires via informal translations. In general, those wishing to measure the health of members of ethnic groups who are unable to read English might consider using different techniques to gain the information from these groups.

Promoting uptake of influenza vaccination among health care workers: a randomized controlled trial

Abstract: In a randomized controlled trial, an intensive promotional campaign failed to increase the uptake of vaccination against influenza among health care workers. The uptake of vaccination was low.

Changes in sports injuries to children between 1983 and 1998: comparison of case series

Abstract: Background Sports injuries sustained by children are worrying because they prevent and deter participation in physical activity. Before we can address such injuries we need to understand the size of the problem and whether there have been changes in occurrence. A study of sports injuries to children, carried out in a Cardiff Accident and Emergency department in 1983, provided the data against which to compare data gathered in 1998. Methods Data on all sports injuries to children aged 16 and under treated between September and December 1998 were compared with those reported for the same hospital, age group, injury and period in 1983. Results A total of 953 injuries were treated in 1998, representing an increase of 54 per cent [95 per cent confidence interval (CI) 44‐64 per cent]. The male:female distribution remained constant and the majority of injuries were due to rugby and soccer. The number of females injured playing rugby and soccer increased and a wider range of sports led to injuries for both males and females. Amongst 10‐15-yearolds injury risk increased from 1 in 78 for boys in 1983 to 1 in 22 in 1998 (p � 0.0001). For girls, the increase was from 1 in 117 to 1 in 55 (p � 0.0001). The number of soccer- and rugbyrelated fractures increased by 52 per cent (95 per cent CI 22‐87 per cent). Conclusions Sports injury rates have increased considerably over 15 years. With minimal population change, little variation in minor injuries and only small improvements in data capture, the main reason for change appears to be increased participation.

Accessing and using hospital activity data

Abstract: Hospital activity data can be accessed from a variety of sources ranging from hospitals to the Department of Health. These data provide valuable and widely used information, but care is needed in their use and interpretation. Hospital activity rates reflect not only the underlying prevalence and severity of disease, individual factors and referral practices, but also variations related to provider-specific factors: the 'provider effect'. This includes completeness in the data, supply of hospital beds, admission policies, hospital access and distance from hospital. The provider effect can be controlled to a certain extent in statistical analyses. Although data quality has improved considerably in the last decade, this should still be investigated where trusts are being compared and in small area studies because missing data may lead to artefactual differences in rates. 'Dump' postcodes, where missing or unknown postcodes are assigned to a local postcode such as that of the hospital, may affect small area analyses and linkage if a proxy patient identifier is constructed that includes postcode.

Retirement intentions of doctors who qualified in the United Kingdom in 1974: postal questionnaire survey.

Abstract: Background: Medical workforce planning needs to be informed by knowledge about doctors' retirement intentions. Systematic information about retirement intentions, and factors that influence them, is sparse. Methods: Postal questionnaires were sent to members of a cohort of medical qualifiers surveyed regularly since they qualified in 1974, with quantitative analysis of intentions about early retirement and qualitative analysis of reasons for wanting early retirement. Results: A total of 1717 replies were received from 2217 traceable doctors (77.4 per cent). Of these, 1427 doctors worked in the NHS and answered the question about retirement: 14.8 per cent (211) said that they would definitely continue to normal retirement age and 20.1 per cent (287) probably would. Of those not definitely continuing to normal retirement age, 45.1 per cent had made financial provision to support early retirement. Seventy per cent cited reasons for considering early retirement: the main reasons were to reduce work-related pressure, increase leisure time, job dissatisfaction, disillusionment with the NHS, and wanting a healthy retirement. Doctors might be encouraged to stay by more flexible working patterns, a reduction in workload with increasing age, improved staffing levels, preservation of pension rights for part-time working, fewer NHS administrative changes, and greater professional freedom. Conclusion: The impact of early retirement on medical workforce supply may be considerable. Approaches to retirement policy need to shift away from the extremes of either full-time employment or total retirement.

The efficiency of the delivery of neonatal care in the UK.

Abstract: BACKGROUND A recent paper in Journal of Public Health Medicine (O'Neill et al., 2000; 22(1): 108-115) used regression modelling to determine the average costs of neonatal care services for a sample of 49 units in the United Kingdom in 1990-1991, and concluded that economies of scale were present in the sample as a whole. Although this form of modelling is useful, analysis of the efficiency of production for individual units is also important. METHODS Data envelopment analysis (DEA) was used to analyse the data set published by O'Neil et al., to determine technical efficiency of neonatal units, measuring efficiency compared with a benchmark efficient frontier, and estimating economies of scale for each unit. Potential cost savings if units were to operate efficiently are estimated. RESULTS There is evidence of substantial levels of technical inefficiency. Economies of scale varied between units, with increasing returns in the 36 inefficient units, and mainly constant returns in the 13 efficient units. This suggests that the presence of technical inefficiency was as important as scale inefficiencies. Total cost savings, if all units were operating efficiently, are estimated at l10.4 million, equivalent to 10 extra units producing 57,000 additional days of care. CONCLUSIONS DEA is a technique of great potential value in analysing the efficiency of health care production. As well as inefficiencies in the production of neonatal care in the United Kingdom due to differences in the scale of production, there appears to have been considerable technical inefficiency, which was not due to differences in case mix. The potential cost savings from efficiency gains are large.

Hidden need for drug treatment services: measuring levels of problematic drug use in the North West of England

Abstract: Background In the North West of England, data on drug users are routinely collected from a variety of agencies including specialist treatment centres, police and probation services. However, the covert nature of drug use means that alone, these conventional monitoring systems cannot provide the epidemiology required to target and develop drug treatment and prevention initiatives. Methods Utilizing surveillance data and capture‐recapture techniques we estimate the rates of problematic drug users by age and sex in five North West health authorities and one local authority. Results Analyses show concentrations of problematic drug use in large metropolitan areas (Liverpool and Manchester) with levels as high as 34.5 and 36.5 per 1000 population (ages 15‐44), respectively, and, for males, levels exceed 50 per 1000 in three authorities. Patterns of prevalence for those aged 25 and over differed from those in the younger age groups, with disproportionate levels of young users outside metropolitan areas. The proportion of young users already in treatment (21.3 per cent) was lower (older users, 35.3 per cent), with overall proportions in treatment varying between health authorities (range 26.2‐46.5 per cent). Conclusion With a multi-agency approach, established monitoring systems can be used to measure hidden populations of drug users. Estimates of the current populations of such users in the North West of England suggest that planned increases of people in treatment by 100 per cent would fail to accommodate even current level of problematic users. A holistic approach to new initiatives must ensure that the high level of relapse once drug users are discharged are reduced and that the needs of young users are addressed before prolonged treatment is required.

The role of community pharmacists in prescribing medication for the treatment of head lice.

Abstract: Background The aim of the study was to discover whether the use of community pharmacy, rather than general practice, as the first port of call for suspected head lice infestation would represent an acceptable, effective and cost-reducing means of management in the community. Methods A before-and-after study was carried out of a new system of care delivery. Between September and November 1997, pharmacists in Nottingham City West recorded details of all patients attending with prescriptions for head lice treatment or those purchasing over-the-counter medication. The new system of care delivery began in January 1998, during which, pharmacists were providing advice and treatment for head lice, in the absence of a referral from general practice. Changes in prescribing behaviour were assessed from Prescribing Analysis and Cost (PACT) data. Acceptability and subjective assessment of the scheme (patients and professionals) was gauged from questionnaires. Results Referral patterns were altered drastically (away from general practice and towards self-referral) by the project, and the changes were apparent within the first month. This trend continued throughout and beyond the formal evaluation period. Cost analysis suggests that the community pharmacy scheme generates resource savings, largely driven by the lower cost of a pharmacy consultation, as opposed to a GP consultation. Questionnaire evidence suggests that both patients and health care professionals viewed the new arrangement as at least as acceptable as the old. Conclusion With respect to the original objective, the new delivery system appears to provide no evidence of ineffectiveness; evidence of acceptability on the part of the majority of patients and professionals; and evidence of improved cost-effectiveness.

Examining the direct costs and effectiveness of syphilis detection by selective screening and partner notification

Abstract: Summary Selective screening and partner notification are two principal means of preventing and controlling syphilis in the United States, yet few studies have been undertaken to compare and evaluate the cost or effectiveness of detecting syphilis using either strategy. The objective of this paper is to assess from the perspective of a health department the costeffectiveness of selective screening compared with the strategy of partner notification in the detection of early syphilis in Houston, Texas, in 1994 and 1995. The cost-effectiveness analysis was performed using the recurring direct costs associated with detecting syphilis by both strategies. The middle estimates for the total direct costs associated with selective screening and partner notification were $579 101 and $229 529, respectively, for the 1466 and the 567 cases of early syphilis detected. On a cost per case basis, selective screening was more cost-effective than partner notification in the detection of primary, secondary and maternal syphilis cases. However, when consideration was given to prophylactic treatment, partner notification was more cost-effective in the detection of all early stage disease. Our findings suggest that the relative benefit of partner notification over selective screening depends on prophylactic treatment and an increase in worker productivity.

Obstacles to influenza immunization in primary care

Abstract: Background General practices undertake annual immunization campaigns to protect susceptible patients against influenza. Many practices, however, do not adopt effective approaches and there is great variation in the immunization rates achieved. This study aimed to assess the attitudes of primary care staff to the annual immunization programme, the obstacles they face, and possible reasons for the wide variation in immunization rates. Method A semi-structured questionnaire survey of general practice groups in Salford & Trafford during winter 1997‐1998 was carried out, a total of 104 practices. Results Respondents perceived influenza vaccine to be effective (93.2 per cent), well received by patients (91.7 per cent) and without significant side-effects (83.6 per cent). The annual immunization programme was seen as being necessary (91.8 per cent), cost-effective (76.7 per cent), reducing hospital admissions (82.2 per cent), but very time consuming (64.4 per cent). Practices were more likely to target patients specified in the Chief Medical Officer’s guidelines; however, most (98.6 per cent) targeted the over-75s before their inclusion in the guidelines, and many (61.6 per cent) targeted the over-65s. Practices did not always use the most effective methods of contacting patients, primarily relying on posters (97.3 per cent), opportunistic contacts (95.9 per cent) and reminders on prescriptions (83.6 per cent), rather than letters (39.7 per cent) and telephone calls (11.0 per cent). Practices identified several common obstacles to immunization, relating to the cost and administrative burden of the annual immunization programme, difficulty identifying high-risk patients, and public beliefs about influenza and influenza vaccine. Conclusions Although generally positive towards influenza immunization, practice staff differ in their ability to cope with, and the appropriateness of their response to, the pressures of the annual immunization programme. Additional support and co-operation from the Department of Health, Health Authorities and pharmaceutical companies could remove some of the obstacles to immunization of high-risk patients.

Winter emergency pressures for the NHS: contribution of respiratory disease, experience in North Staffordshire district

Abstract: The rise in emergency medical admissions in winter in the NHS hospitals in the United Kingdom has been recognized to reflect respiratory and cardiovascular illness. In our study we looked at the contribution of respiratory disease to the winter pressures in our district. Respiratory disease related emergency admissions increased twofold in the winter months, with obvious implications for workload. An evidence-based National Service Framework for respiratory disease would be useful.