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Biomedical subjects

Andrew W Murphy

Publications and source records attributed to Andrew W Murphy.

13 recordsLinked to original sources
PubMed2006

A qualitative study of factors influencing antimicrobial prescribing by non-consultant hospital doctors.

OBJECTIVES: To determine the factors that influence non-consultant hospital doctors (NCHDs) in their decision to prescribe antimicrobial agents. METHODS: A qualitative study using semi-structured interviews centred on a life grid tracking the medical career of 22 NCHDs employed by a university teaching hospital in the west of Ireland. RESULTS: Early in their careers NCHD prescribing is based primarily on the immediate influence of more senior colleagues. Recollection of formalized undergraduate teaching and hospital guidelines are a very minor influence. As their career progressed and they exercise greater autonomy, personal experience becomes the major influence on prescribing decisions. Hospital guidelines are a minor influence. Participants consider that undergraduate teaching needs to be more practical and taught in a way that is easier to apply to on-ward situations and that hospital prescribing guidelines need to be presented in a 'user-friendly' format and adherence to the guidelines needs to be promoted. CONCLUSIONS: The key influences on antimicrobial prescribing by NCHDs are informal. New approaches are required to ensure that formal training and hospital guidelines on antimicrobial prescribing are more influential in shaping antimicrobial prescribing practice.

Anti-Bacterial Agents↗
PubMed2006

The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems.

BACKGROUND: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems. METHODS: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis. RESULTS: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change. CONCLUSION: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

Aged↗
PubMed2006

Patients and health professionals' perspectives on the sociocultural influences on secondary cardiac behaviour: a qualitative study of the implications in policy and practice.

OBJECTIVES: To explore the similarities and differences between patients and health professionals' perspectives on the sociocultural influences on secondary cardiac behaviour, and the implications in policy and practice. METHODS: Qualitative study using grounded theory research. We used a linked, phased study to ascertain the factors which helped shape patients' views about their heart problems and how these influence secondary cardiac behaviour. We also explored health professionals' perspectives on patients' views and interpretations. A total of 70 participants, 56 patients and 14 health professionals, took part in individual and group interviews and focus groups. RESULTS: Patients seemed in control of their heart condition and communicated a sense of satisfaction in how they manage it. To interpret the sociocultural influences on secondary cardiac behaviour, patients used theirs and community knowledge of heart disease, personal constructions of cardiac illness, together with their individual belief systems, particularly relating to lay health beliefs. Individual interpretations were unique and contextual, but there were many common views which did not differ between patients. CONCLUSIONS: Patients and health professionals reported similar areas of influence but there were important differences in emphasis. Providers described the ambivalence between being positive about the future health of patients to boost their recovery process, and recognition that this positive outlook could be construed as a 'cure'.

Adult↗
PubMed2006

A cross-sectional study of secondary cardiac care in general practice: impact of personal and practice characteristics.

OBJECTIVE: To determine the impact of patient (age, gender, type of and time since diagnosis) and practice (rurality, number of partners, availability of practice nurse) characteristics on secondary cardiac care in general practice in a country without universal registration. METHODS: Medical and demographic data were gathered from the medical charts of 1611 eligible patients from 35 randomly selected practices. Eligible patients were aged under 80 years with a recorded history of acute myocardial infarction, percutaneous trans coronary arteriogram or angina. Self-report data about diet, exercise, smoking and alcohol consumption were provided from postal questionnaire (1084 patients responded; 69% response rate). RESULTS: Having an angina only diagnosis significantly decreased the likelihood of patients being prescribed aspirin (OR = 0.53; 95% CI = 0.40-0.69), lipid-lowering medication (OR = 0.55; 95% CI = 0.43-0.69) or ACE inhibitors (OR = 0.62; 95% CI = 0.48-0.81). Younger patients (OR = 1.05; 95% CI = 1.04-1.06) were also more likely to be prescribed lipid-lowering medication. Cholesterol was predicted by gender only, with females having significantly higher cholesterol (B = -0.41; 95% CI = -0.54 to -0.27). The number of missed opportunities for secondary cardiac care was greater among patients with angina only (B = 0.39; 95% CI = 0.19-0.60). The amount of variance explained by practice and patient variables overall for each of the measures was small, ranging from 2 to 6%. CONCLUSIONS: Practice size or location appears to have little impact on secondary cardiac care. The most consistent significant personal characteristic finding was that patients with a diagnosis of angina only were significantly less likely to receive aspirin, statins or ACE inhibitors and more likely to have more missed opportunities for secondary cardiac care.

Age Factors↗
PubMed2006

Helping each other to learn--a process evaluation of peer assisted learning.

BACKGROUND: The benefits of Peer Assisted Learning (PAL) are well established with positive effects on examination scores, student satisfaction and personal and professional development reported. PAL is increasingly utilised as a resource within medical education where the restrictions on resources have forced teachers to look at creating new educational environments which can be delivered at a lower cost. This study sought to evaluate the processes at work as the emphasis of PAL research to date has largely been on the consideration of student outcomes. METHODS: Fifth-year medical undergraduates, who had completed their communication skills modular training and attended a preparatory workshop, facilitated a role-play session for their second-year colleagues within an Early Patient Contact programme. Semi-structured interviews and focus groups were used to collect data at different time points in order to establish the views of peer learners and tutors towards this new method of teaching. The data was analysed according to the principles framework analysis using N-vivo software. Themes were shared and debated with the multidisciplinary team of authors and a concordance of views on common themes was reached after discussion and debate. RESULTS: Analysis of the data resulted in the emergence of three thematic categories: Learning Environment, Educational Exchange and Communication and Modelling. The data demonstrated a concordance of the views between peer tutors and learners on barriers and levers of this approach as well as a heightened awareness of the learning environment and the educational exchange occurring therein. CONCLUSION: The data is significant as it not only demonstrates a high level of acceptability among tutors and learners for PAL but also indicates the reciprocity of educational exchange that appears to occur within the PAL setting. This study highlights some of the unique characteristics of PAL and we recommend the development of further qualitative studies around peer learners and tutors views of this process.

Adult↗
PubMed2006

Cluster randomized controlled trials in primary care: an introduction.

BACKGROUND: Cluster randomized trials occur when groups or clusters of individuals, rather than the individuals themselves, are randomized to intervention and control groups and outcomes are measured on individuals within those clusters. Within primary care, between 1997 and 2000, there has been a virtual doubling in the number of published cluster randomized trials. A recent systematic review, specifically within primary care, found study quality to be both generally lower than that reported elsewhere and not to have shown any recent quality improvement. OBJECTIVE: To discuss the design, conduct and analysis of cluster randomized trials within primary care in terms of the appropriate expertise required, potential bias, ethical considerations and expense. DISCUSSION: Compared with trials that involve the randomization of individual participants, cluster randomized trials are more complex to design and analyse and, for a given sample size, have decreased power and a broadening of confidence intervals. Cluster randomized trials are specifically prone to potential bias at two levels-the cluster and individual. Regarding the former, it is recommended that cluster allocation be undertaken by a party independent to the research team and careful consideration be given to ensure minimal cluster attrition. Bias at the individual level can be overcome by identifying trial participants before randomization and at this time obtaining consent for intervention, data collection or both. A unique ethical aspect to cluster randomized trials is that cluster leaders may consent to the trial on behalf of potential cluster members. Additional costs of cluster randomized trials include the increased number of patients required, the complexity in their design and conduct and, usually, the need to recruit clusters de novo. CONCLUSION: Cluster randomized trials are a powerful and increasingly popular research tool. They are uniquely placed for the conduct of research within primary-care clusters where intracluster contamination can occur. Associated methodological issues are straightforward and surmountable and just need careful consideration and management.

Bias↗
PubMed2006

Development of a complex intervention for secondary prevention of coronary heart disease in primary care using the UK Medical Research Council framework.

OBJECTIVE: To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. STUDY DESIGN: Case report of intervention development. METHODS: First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants' experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). RESULTS: Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information. CONCLUSION: Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.

Clinical Trials as Topic↗
PubMed2005

The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411].

BACKGROUND: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland. CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines. METHODS: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

Journal Article↗
PubMed2005

Secondary prevention of coronary heart disease: patient beliefs and health-related behaviour.

OBJECTIVE: Coronary heart disease (CHD) is a leading cause of illness and death in Western society. The present study was designed to evaluate the utility of illness perceptions and medication beliefs in predicting secondary preventive behaviour among patients with CHD. An extended version of Leventhal's self-regulatory model (SRM) was used as a theoretical framework for this study [Leventhal H, Nerenz DR, Steele DJ. Illness perceptions and coping with health threat. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health, Volume IV: social psychological aspects of health. Hillsdale (NJ): Erlbaum, 1984. pp. 219-52; Horne R, Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health 2002;17(1):17-32]. METHOD: Medical and demographic data were gathered from the medical charts of 1611 patients with established CHD from 35 randomly selected general practices. Self-report data about patients' lifestyles (diet, exercise, smoking, alcohol consumption and medication adherence) and information on illness and medication beliefs were provided from postal questionnaire (1084 patients responded; 69% response rate). The relationship between patients' beliefs and their secondary preventive behaviour was examined using regression analyses. RESULTS: Illness perceptions appeared to be only weak predictors of smoking, exercise, diet, alcohol consumption and medication adherence, accounting for about 2% of the variance in these behaviours. Medication beliefs were moderately related to medication adherence, accounting for about 7% of the variance in scores. A strong belief in the necessity of one's medication and a lower level of concern about one's medication were associated with higher levels of adherence. CONCLUSIONS: An illness perception approach did not prove helpful in predicting secondary preventive behaviour among this group of patients. However, beliefs about medications appear to be reasonable predictive of medication adherence.

Aged↗
PubMed2004

The potential use of prehospital thrombolysis in a rural community.

BACKGROUND: It is recommended that eligible patients receive thrombolytic treatment within 90 min of alerting medical or ambulance services. The Donegal Area Rapid Treatment Study (DARTS) showed that pre-hospital thrombolysis reduces "call to needle" times for patients living remote from the hospital base [Donegal Area Rapid Treatment Study (DARTS): Final Report. North Western Health Board]. AIM: To review DARTS data to describe the potential impact of pre-hospital thrombolysis on a defined population. METHOD: Data from the DARTS project was reviewed to describe cases where thrombolysis was not administered, cases where thrombolysis was administered in hospital but not in the community, and to extrapolate these findings to other rural regions in the area to identify the potential for additional pre-hospital thrombolysis. RESULTS: Eighty-four patients from DARTS practices presented to the district hospital with AMI during the study period with 35% (29/84) receiving thrombolysis. Of the 29 who received thrombolysis, 87% (25) were referred from the general practitioner. Of these, 32% (8/25) were administered thrombolysis by the general practitioner. Of the general practitioner referrals that did not receive pre-hospital thrombolysis (n = 17), 65% (11/17) were not thrombolysed in the community for appropriate clinical reasons and 35% (6/17) could have been potentially eligible for pre-hospital thrombolysis. Inclusion of these patients suggests a potential pre-hospital thrombolysis rate in the region of 56%. For the rural Donegal areas this would result in a potential 17 cases per year being eligible for pre-hospital thrombolysis. CONCLUSIONS: Currently, 35% of the 240 AMIs that occur annually in the region receive thrombolysis. Broad implementation of DARTS in the region would provide pre-hospital thrombolysis to approximately an additional 25 patients each year, with a potential for further gains. For this to become a reality, support and encouragement must be provided to all rural general practitioners, the ambulance services, receiving hospitals and policy makers to implement a pre-hospital thrombolysis policy.

Adult↗
PubMed2004

Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction: an evaluation of the Self-Regulatory Model of illness behaviour.

OBJECTIVE: The aim of this study was to determine the usefulness of the Self-Regulatory Model (SRM) of illness behaviour [Leventhal J, Meyer D, Nerenz D. The common-sense representation of illness danger. In: Rachman S, editor. Medical psychology. New York (NY): Pergamon, 1980, pp. 27-30.] as a framework for explaining prehospital delay in patients with acute myocardial infarction (AMI). METHOD: Data were collected from 61 patients with confirmed AMI regarding demographics, clinical history, distance from hospital and components of the SRM. RESULTS: The median time from onset of symptoms to arrival at Accident and Emergency (A&E) was 4 h 4 min. A hierarchical multiple regression revealed that the components of the SRM explained 37% of the variance in prehospital patient delay. Males who viewed a heart attack as having serious consequences and who adopted an active-cognitive and problem-focused coping response to their symptoms had the shortest delay times. CONCLUSION: The SRM is a useful framework for partially explaining patient delay. There are, however, complex interactions between the physical manifestation of pain and symptomatology and patient response. Patients' perceptions of the severity of the consequences of an AMI appear to override the effects of an individual's emotional response to the acute event. Interventions should teach patients the skills associated with active-cognitive and problem-focused coping and take account of gender differences in their design.

Adaptation, Psychological↗