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Biomedical subjects

Ann Bowling

Publications and source records attributed to Ann Bowling.

15 recordsLinked to original sources
PubMed2006

Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing.

BACKGROUND: there is increasing interest in how to age 'successfully' and in reaching consensus over its definition. OBJECTIVE: to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1. SETTING: community settings in Britain. METHODS: five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based. RESULTS: the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) = 2.655-11.364]. CONCLUSION: the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations.

Aged↗
PubMed2006

Variations in cardiac interventions: doctors' practices and views.

OBJECTIVES: To investigate referral rates for cardiac interventions by clinical specialty, to document doctors' reasons for referrals and to explore doctors' perceptions of the factors that influenced their clinical decisions. STUDY DESIGN: Doctors completed a clinical decision-making exercise involving, in total, 6093 electronic patients with cardiac disease, and subsequently took part in the semi-structured interviews about influences on their decisions. Interviews were audio-recorded, transcribed and coded using a thematic approach, with the coding categories derived from the data. STUDY SETTING: Eighty-eight doctors (GPs, care-of-the-elderly specialists, cardiologists) participated in the full study, in seven areas in southern, central and northern England. Complete interview data were analysed for 76 of these. PRINCIPAL FINDINGS: Not all patients who were eligible for specific investigations or treatment received these. The extent of variations in clinical decisions differed by type of intervention. Apart from the general reasons for referrals, doctors raised nine main influences on their actual decision making. The most commonly reported influence ('barrier') was poor access to equipment for intervention, which increased thresholds for investigation and treatment. CONCLUSIONS: The current emphasis on achieving targets in the British NHS has led to a focus on easily measurable, but crude, process targets such as waiting lists. This study points to the need to include a broader quality assurance element to investigate the cluster of system failures which lead to variations in clinical decisions and thereby to inequitable treatment.

Cardiology↗
PubMed2006

Do perceptions of neighbourhood environment influence health? Baseline findings from a British survey of aging.

OBJECTIVES: To investigate the relation between perceived neighbourhood environment, social contact and support, and self efficacy, on the health of older people. DESIGN: British cross sectional population survey of people aged 65 and over. PARTICIPANTS: 999 people aged 65 plus living at home in Britain. RESULTS: Regression modelling showed that high self efficacy had a strong independent association with better self rated health status and physical functioning. Indicators of perceived neighbourhood environment that showed strong associations with both good health and functioning were: perceptions of good quality facilities in the area (social/leisure, facilities for people aged 65+, rubbish collection, health services, transport, closeness to shops, somewhere nice to walk), and high levels of neighbourliness (knows/trusts people). Perceptions of problems in the area (noise, crime, air quality, rubbish/litter, traffic, graffiti) were also predictive of poorer health. Measures of social contact and support did not show any independent associations with health or functioning. CONCLUSIONS: The unique value of this paper is in the simultaneous analysis of associations between perceived neighbourhood, social contact and support, self efficacy, and health. The consistent strength of older people's perceptions of the quality of facilities in their neighbourhoods shows that responsive reinforcement of local infrastructures might have wider health benefits. Also of interest was the strength of self efficacy as a predictor of self rated health and physical functioning. The results have implications for both neighbourhood level interventions and self management programmes in chronic illness.

Aged↗
PubMed2005

Mode of questionnaire administration can have serious effects on data quality.

BACKGROUND: One of the main primary data collection instruments in social, health and epidemiological research is the survey questionnaire. Modes of data collection by questionnaire differ in several ways, including the method of contacting respondents, the medium of delivering the questionnaire to respondents, and the administration of the questions. These are likely to have different effects on the quality of the data collected. METHODS: This paper is based on a narrative review of systematic and non-systematic searches of the literature on the effects of mode of questionnaire administration on data quality. RESULTS: Within different modes of questionnaire administration, there were many documented potential, biasing influences on the responses obtained. These were greatest between different types of mode (e.g. self-administered versus interview modes), rather than within modes. It can be difficult to separate out the effects of the different influences, at different levels. CONCLUSIONS: The biasing effects of mode of questionnaire administration has important implications for research methodology, the validity of the results of research, and for the soundness of public policy developed from evidence using questionnaire-based research. All users of questionnaires need to be aware of these potential effects on their data.

Bias↗
PubMed2004

Assessing patients' preferences for treatments for angina using a modified repertory grid method.

A current popular theme in medicine concerns whether and how patients should be involved in treatment choice. Assuming patient involvement is desirable, how should one go about eliciting preferences? A variety of quantitative and qualitative methods exist that may be used for this purpose, one of which is the repertory grid method. This method involves eliciting constructs (reasons) for preferences through comparing sets of three options. This method allows the structured elicitation of the reasons behind individual preferences, but also, when used with generalised procrustes analysis (GPA), allows aggregation of individual data to reveal general preference patterns. In this study the repertory grid method was used to examine patient preferences for angina treatments with the goal of, first, gaining some understanding of general patterns of patient preference, and second, examining the likely utility of the technique in this setting. A sample of 21 patients with mild and stable angina from two general practices in Norfolk, UK was interviewed using the repertory grid method to elicit the constructs underlying their preferences amongst seven angina treatments (including 'no treatment'). Individualised questionnaires were then produced and sent to the patients for self-completion, which required rating the extent to which each construct was relevant for each treatment (scored on visual analogue rating scales). Analysis of the ratings, using GPA, showed that the constructs clustered around two dimensions: 'some treatment' versus 'no treatment', and drug treatment versus surgical treatment. While some treatment was generally preferred to no treatment, individuals varied in preference for drug treatments or surgical treatments. Although the latter were generally perceived as 'effective' they were also perceived, for example, as 'invasive', 'frightening', related to 'negative experiences', and being more appropriate for when symptoms are severe ('proportionate'). We consider the implications of these results for involving patients in choosing amongst treatments.

Adult↗
PubMed2004

Reasons underpinning patients' preferences for various angina treatments.

OBJECTIVE: To elicit patients' preferences for the treatment of angina. DESIGN: Angina patients were interviewed in order to elicit their personal reasons underlying preferences for various treatment options. Interviews followed a general repertory grid technique, in which seven treatment options were presented to patients in triads. Treatments considered ranged from medication to invasive revascularization therapies, with a 'no treatment' option. SETTING: Two general practices in Norwich, Norfolk. SUBJECTS: Twenty-one patients with diagnosed angina, which was both mild and stable. MAIN OUTCOME MEASURES: Treatment preferences verbalized by patients during interview, and the underlying reasons for these. RESULTS: Attitudes voiced towards the range of treatments for angina were diverse; 27 different reasons underlying patients' preferences were identified. Patients' preferences were largely justified by reasons associated with the conditional effectiveness or otherwise of treatments. When presented with treatment triads, medication (drug) treatments were over 2.5 times more likely to be chosen as a most preferred option than invasive or surgical treatments. Although surgical treatments were generally considered to be 'effective', it was perceived that they were more appropriate for situations when the condition became life-threatening. There were occasions, however, when preferences were driven by other reasons, such as a desire to avoid surgery because it was perceived negatively as 'invasive' and 'frightening'. Drug treatments were viewed as 'quick', 'easy' and reversible. Personal experiences of the effectiveness or otherwise of treatments were frequently cited as reasons for stated preferences. However, patients often commented that they would prefer the doctor to make the decision about their treatment. CONCLUSIONS: Patients choices among treatments was largely driven by perceptions of their effectiveness or otherwise. Although surgery was perceived as 'effective' it was also seen as conditionally so, dependent upon severity of the condition - which is not necessarily the case, as the risks of adverse events and surgical complications increase for emergency cases. As such, access to better information about the effectiveness and timeliness of interventions is needed. Although respondents held anxieties about treatment, particularly invasive or surgical treatments, fewer choices were driven by emotional and lifestyle factors unrelated to 'effectiveness', such as fear or ease of treatment.

Adult↗
PubMed2003

Does ageism affect the management of ischaemic heart disease?

OBJECTIVES: To analyse access by age to exercise testing, coronary angiography, revascularisation (percutaneous transluminal coronary angioplasty/stent insertion and coronary artery bypass graft surgery) and receipt of thrombolysis, where indicated, for hospital patients with diagnosed cardiovascular disease. METHOD: Retrospective case note analysis, tracking each case backwards and forwards by 12 months from the patient's date of entry to the study. The setting was a district hospital in the eastern part of outer London. The case notes eligible for inclusion were those of elective and emergency in-patients with an in-patient ICD-10 code of ischaemic heart disease, angina pectoris or acute myocardial infarction and a consecutive 20% sample of new cardiac outpatients with these diagnoses. RESULTS: Analysis of 712 case notes showed that older hospital patients with ischaemic heart disease, and with indications for further investigation, were less likely than younger people to be referred for exercise tolerance tests and cardiac catheterisation and angiography. This was independent of both gender and severity of condition. Older patients did not appear to be discriminated against in relation to receipt of indicated treatments (revascularisation or thrombolysis), although, in the case of revascularisation, older patients were more likely to have been filtered out at the investigation stage (catheterisation and angiography), so selection bias partly explains this finding. CONCLUSIONS: The current findings from a single hospital are comparable with the results from a broader study of equity of access by age to cardiological interventions in another district hospital in the same region. Although only two hospitals were analysed, the similarity of findings enhances the generalisability of the results presented here. It appears that age per se causes older cardiac hospital patients to be treated differently.

Age Factors↗
PubMed2003

Let's ask them: a national survey of definitions of quality of life and its enhancement among people aged 65 and over.

This study aimed to explore older peoples' definitions of, and priorities for, a good quality of life for themselves and their peers. Nine hundred and ninety-nine people aged 65 and over, living at home in Britain, were interviewed for the study. Good social relationships were the most commonly mentioned constituent that gave respondents' lives quality (mentioned by 81 percent). Other important factors were social roles and activities, health, psychological outlook and well-being, home and neighborhood, finances, and independence. Poor health was most often mentioned as taking quality away from life (by 50 percent). Social relationships and health were judged to be the most important areas. Having health and enough money were the two most frequently mentioned things that would improve the quality of their own lives and those of their peers (though in different order of magnitude). The need for dynamic, multidimensional, and integrated models of quality of life in older age is suggested by these results.

Adaptation, Psychological↗
PubMed2002

Age- and sex-related bias in the management of heart disease in a district general hospital.

OBJECTIVE: To investigate the clinical management of heart disease and determine whether there was age- and sex-related bias in the use of investigations and interventions. DESIGN: Retrospective analysis of individual patient records against criteria of appropriateness based on published guidelines, clinical practice and literature relevant to the 1996-7 study period. SETTING: A single, district general hospital in London, serving a population of 185,000 people. SUBJECTS: General medical, elderly medical, and cardiology inpatients and patients attending elderly medical and cardiology outpatient clinics as new referrals between 1 April 1996 and 31 March 1997. RESULTS: We located case notes of 1790 of the 1975 subjects eligible for the study: 911 (51%) were outpatients and 51% were men. Patients aged <75 were significantly more likely than patients aged >or=75 years to be given thrombolysis after an acute myocardial infarction, to be given secondary prevention with aspirin and beta-blockers, to undergo exercise testing and coronary angiography, and to receive an echocardiogram. Men were also significantly more likely than women to have these investigations and interventions as well as to receive an angiotensin-converting enzyme inhibitor when left ventricular dysfunction was identified. Investigations and interventions were underused at all ages. CONCLUSION: As well as identifying age and sex bias, we found the underuse of investigations and interventions in all age groups in this district general hospital. Should similar patterns of care be found elsewhere, the delivery of high-quality care in an equitable manner (as identified by the National Service Framework for coronary heart disease) may require considerably more resources than have been allocated.

Age Factors↗
PubMed2002

Are older people willing to give up their place in the queue for cardiac surgery to a younger person?

OBJECTIVES: to measure whether people aged 65 and over living in Britain would be willing to give up their place on the cardiac surgery waiting list for someone younger than them. METHODS: two British surveys, based on random types of people sampled for the Office for National Statistics Omnibus Surveys, identified respondents aged 65 and over for a module on waiting lists. They were asked to imagine they had a heart condition that required surgery, and that they were on an NHS waiting list. They were then asked if they would be prepared to give up their place on the cardiac surgery waiting list to a younger person (aged 45). The study compared responses to one of two relative waiting list time frames (6 and 12 months). SETTING: two national random samples of the British public aged 65 and over. RESULTS: fifty eight per cent and 62% of Omnibus respondents aged 65 and over responded that it was not right to give up their place on the cardiac surgery waiting list for someone younger in relation to a 6 and 12 month wait respectively. Thirty seven per cent and 34% of each group of Omnibus respondents aged 65+ said it was right to give up their place on the cardiac surgery waiting list for someone younger than them, in relation to a 6 and 12 month relative waiting period respectively. Thus the length of the wait had little effect on response among British respondents. The proportions who were willing to cede priority are far less than that reported in a comparable Italian survey. Consistent with the Italian survey, willingness to cede priority increased with age. CONCLUSIONS: most older people in Britain do not wish to cede priority on the waiting list for cardiac surgery to people younger than themselves, although willingness to give up one's place increased with age. The specific time frame did not have an impact on people's responses. The increase in willingness to cede priority with older age could be interpreted as older people valuing themselves less, or that they feel that they have had their 'fair innings' and are willing to give younger people the chance of reaching their age. It could even reflect a cohort effect. It is likely that ageing 'baby boomers' may be even less willing to give up their place in the health service queue and will be more assertive about their right to equity in health care provision.

Aged↗