243 research outputs found
How can health services research inform health policy? A case example in emergency and urgent care (Presentation)
No full textIntegrated out-of-hours care arrangements in England: Observational study of progress towards single call access via NHS Direct and impact on the wider health system.
No full textPreferences of patients for emergency services available during usual GP surgery hours: a discrete choice experiment
No full textObjective: A study was undertaken to investigate patients' strength of preferences for attributes or characteristics associated with delivery of emergency primary care services available during usual GP surgery hours and to investigate the trade-offs between attributes. Methods: A discrete choice experiment was used to quantify patients' strength of preferences for several key attributes of usual-hours emergency primary care. The attributes were chosen to reflect the findings of previous research, current policy initiatives and discussions with local key stakeholders. A self-complete questionnaire was administered to NHS Direct callers and adult attenders at Accident and Emergency, GP services and the NHS Walk-in Centre in the locality. Regression analysis was used to estimate the relative importance to patients of the different attributes. Results: An overall response of 71% (n = 432) was achieved. All but one of the attributes was a statistically significant predictor of preference. The attribute ‘being kept informed about waiting time’ was the most important. This was followed by ‘quality of the consultation’, ‘having a consultation with a nurse’, ‘having a consultation with a doctor’ and ‘contacting the service in person’. Respondents were prepared to wait an extra 68 min to have a consultation with a doctor, but an extra 2 h 9 min for information about expected waiting time. There were no measurable preference differences between patients surveyed at different NHS entry points. Respondents younger than 45 years held strong preferences with respect to how they wanted to make contact with the system, whereas older respondents appeared not to hold strong preferences, seemingly indifferent between the alternatives. There was weak evidence which showed the younger group more strongly preferred accessing services via an integrated telephone system than making contact in person. Conclusions: This study showed that local solutions for reforming emergency primary care during hours when the GP surgery is open should take account of the strength of patient preferences. The discrete choice method was acceptable, and the results directly informed the development of a local service framework for such care
Unidentified Man (possibly Mulford Lattimer)
No full textThis circa 1860s image is a carte-de-visite of an unidentified man. The individual is probably associated with the 3rd Michigan Cavalry and is most likely Captain Mulford M. Lattimer of Company E
Safety, effectiveness and costs of different models of organising care for critically ill patients: literature review
No full textNew ways of working in critical care are emerging in response to increasing demands for care in the context of a limited critical care workforce. This review appraised the comparative safety, effectiveness and costs of new ways of working in critical care. All papers published in peer reviewed journals during 1990–2003 were utilised. A total of 933 potentially relevant papers were identified. Secondary sources including policy papers, and experts within the field were also used to inform this work. Initially 113 papers met the inclusion criteria. However, 58 of these described policy and secular trends in critical care and were therefore used only to provide background information. A total of 55 papers were then critically reviewed to provide academic focus on the subject area. Examples of comparative empirical research on new ways of working were limited, but the review revealed research activity in the areas of: impact of workload; nursing, medical and organisational factors affecting patient outcomes; and methods to support workforce calculations. The findings suggest that research into longer-term patient outcomes is needed together with a proactive and strategic interdisciplinary approach to practice, policy and research
Estimating the cost of new partnership arrangements between NHS Direct and local Out-of-Hours health services
No full textGeneral practitioners' perceptions of the appropriateness and inappropriateness of out-of-hours calls
No full textBackground: The number of out-of-hours calls to general practitioners (GPs) has increased steadily during the past 20 years. The proportion of inappropriate calls are reportedly increasing but we know very little about how GPs judge a call to be appropriate or inappropriate.Aim: To determine the factors that influence GPs' perceptions of the appropriateness or inappropriateness of out-of-hours calls.Design of study: Postal questionnaire survey.Setting: GP members of the Wessex Primary Care Research Network (WReN) and the Northern Primary Care Research Network (NoReN).Method: General Practitioners were asked to write down what they meant by an 'appropriate' and 'inappropriate' out-of-hours call. The free text was subjected to content analysis.Results: Detailed responses were received from 146 (73%) GPs. General practitioners appear to have a well developed classification of the appropriateness of out-of-hours calls. Factors that make calls appropriate include not only the nature of patients' symptoms and illness but also non-medical factors such as patients' compliance and politeness.Conclusion: The inclusion by GPs of non-medical factors in their conceptualisation of the appropriateness of out-of-hours calls may contribute to patients' confusion about what is and is not appropriate and also to the apparent failure of patient education initiatives designed to decrease inappropriate demand
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