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Biomedical subjects

Anne Rogers

Publications and source records attributed to Anne Rogers.

At least 19 recordsLinked to original sources
PubMed2006

Implementing and managing self-management skills training within primary care organisations: a national survey of the expert patients programme within its pilot phase.

A key element of the United Kingdom (UK) health policy reform in relation to chronic disease management is the introduction of a national programme seeking to promote self-care from within the National Health Service (NHS). The mainstay of the Expert Patients Programme (EPP) is a six-week training course that provides the opportunity for anyone with a long-term condition to develop new skills to manage their condition better on a day-to-day basis. The course forms part of the NHS self-care support programme, is administered by Primary Care Trusts (PCTs) and delivered by people who have personal experience of living with a long-term condition. The NHS' official Expert Patients Programme website presently states that, "Pilot EPP courses began at 26 NHS PCT sites across England in May 2002, and by May 2004 approximately 300 PCTs had either actively implemented pilot courses or had committed to joining. The majority of PCTs are now coming to the end of the pilot phase, with many implementing plans to make EPP sustainable for the long-term." The NHS website heralds the pilot "a success."A national, postal survey of PCT EPP Leads was undertaken in order to examine both the evolvement of EPP during its pilot stage and future plans for the programme. A questionnaire was sent out to the 299 PCTs known to have committed to the EPP pilot, and an excellent 100% response rate was obtained over a 3-month period (April-July 2005). One marker of success of the Expert Patients Programme implementation is the actual running of courses by the Primary Care Trusts. This paper explores the extent to which the implementation of the pilot can indeed be viewed as a "success," primarily in terms of the number of courses run, and considers the extent to which PCTs have carried out all that they were committed to do. Findings suggest that the more time an EPP Lead dedicates to the Programme, the more likely it is that EPP has run successfully in the past, and the more likely it is that it will continue to run successfully in the future. Other factors indicating future EPP success include collaborating across PCTs to share co-ordinators, tutors, and funding.

Journal Article↗
PubMed2006

The caudal-related homeodomain protein Cdx2 and hepatocyte nuclear factor 1alpha cooperatively regulate the UDP-glucuronosyltransferase 2B7 gene promoter.

The gastrointestinal tract, contains several UDP-glucuronosyltransferases (UGTs) of the UGT1A and UGT2B subfamilies. UGT2B7 is one particular enzyme expressed throughout the gastrointestinal tract that possesses broad substrate specificity towards orally administered drugs. Because the caudal-related homeodomain protein 2 (Cdx2) regulates many gastrointestinal properties, we sought to determine whether it could regulate the UGT2B7 promoter in the colon-derived cell line Caco-2. Levels of Cdx2 and UGT2B7 were measured in differentiated and non-differentiated Caco-2 cells by the quantitative polymerase chain reaction. The capacity of the UGT2B7 gene promoter to drive expression of the luciferase reporter gene was assessed by transfection into Caco-2 cells, with transcription factor expression plasmids. Mutation of putative transcription factor binding sites and electrophoretic mobility shift assays were used to define important regulatory regions of the UGT2B7 gene promoter. The levels of Cdx2 and UGT2B7 mRNAs were co-ordinately increased in differentiated Caco2 cells compared to non-differentiated cells. Cdx2 activates the UGT2B7 proximal promoter by binding to two adjacent sites. Promoter activation requires Cdx2 binding to both sites wherein these proteins interact to form a putative functional dimer. Dimerization was shown to be dependent on redox state using extracts depleted of dithiothreitol. In addition, Cdx2 was shown to cooperatively activate the UGT2B7 promoter in conjunction with hepatocyte nuclear factor 1alpha (HNF1alpha), a mechanism previously observed to regulate other intestine-specific genes. The present study is the first to define transcription factors involved in the control of intestinal UGT2B expression. The demonstration that Cdx2 and HNF1alpha are important regulators of UGT2B7 expression will aid in defining pathways for coordinate control of drug metabolism in the gastrointestinal tract.

Biotransformation↗
PubMed2006

Is self-care a cost-effective use of resources? Evidence from a randomized trial in inflammatory bowel disease.

OBJECTIVES: To determine if a whole-system approach to self-management in inflammatory bowel disease (IBD), using a guidebook developed with patients and physicians trained in patient-centred care, leads to cost-effective use of health system resources. METHODS: Cost-effectiveness analysis over a one-year time horizon comparing the whole systems self-management approach to treatment with usual treatment. Nineteen hospitals in the northwest England were randomized to the intervention or to be controls; 651 patients (285 at intervention sites and 366 at control sites) with established IBD were included. The economic evaluation related differential health service costs, from a UK NHS perspective, to differences in quality-adjusted life years (QALYs) based on patients' responses to the EQ-5D. RESULTS: The intervention was associated with a mean reduction in costs of 148 pounds sterling per patient and a small mean reduction in QALYs of 0.00022 per patient compared with the control group. This resulted in an incremental cost per QALY gained of 676,417 pounds sterling for treatment as usual and a probability of around 63% that the whole-system approach to self-management is cost-effective, assuming a willingness to pay up to 30,000 pounds sterling for an additional QALY. CONCLUSIONS: Although there is uncertainty associated with these estimates, more widespread use of this method in chronic disease management seems likely to reduce health care costs without evidence of adverse effect on patient outcomes.

Cost-Benefit Analysis↗
PubMed2005

Recruitment to a trial of self-care skills training in long-term health conditions: analysis of the impact of patient attitudes and preferences.

The rise of evidence-based practice has highlighted the importance of effective recruitment to randomised controlled trials if studies are to be adequately powered and valid. However, there are also increasing concerns about patient preferences and choice within trials. The current authors are involved in a trial of a programme to provide self-care skills training for people with long-term health conditions (the 'Expert Patients Programme'), and during the design stage there were significant concerns about the impact of patient preferences on the feasibility and validity of the study, because recruitment required that patients risk randomisation to a waiting list control group. This paper first details the issues raised in this trial, and the methods used to attempt to overcome them. Data on recruitment rates, loss to follow up and patient decision making about participation are presented, which suggested that initial assumptions about the impact of patient preferences were incorrect. Key lessons concerning preferences in this patient population and related issues in trial administration are then discussed.

Attitude↗
PubMed2005

Informed consent? How do primary care professionals prepare women for cervical smears: a qualitative study.

BACKGROUND: Cervical screening is a procedure that is mainly carried out in primary care, predominantly by general practitioners (GPs) and practice nurses (PNs). Much has been published about the effects on women of receiving an abnormal smear result but little has been done to investigate the preparation of women by primary care professionals for this. OBJECTIVE: To explore the self-reported behaviours of GPs and PNs in preparing a woman for a cervical smear test and possible abnormal result. METHODS: Letters inviting respondents to participate were sent to selected GPs and PNs at medical student teaching practices in Manchester, England. Twelve GPs and 15 PNs were interviewed. Interviews were audiotaped and covered aspects of the cervical screening programme, practice protocols and explored views about consenting a woman for a smear test and the information giving about the possibility of an abnormal test result. Interviews were analysed by constant comparison and the interview schedule modified. Recruitment for interviews ceased when category saturation was achieved. CONCLUSION: PNs and GPs differed widely in their descriptions of how they prepare a women for a smear. PNs reported following routines which they felt incorporated women's questions and anxieties; GPs reported that the discussion with the woman depended on the reason for doing the smear but also the amount of time available within the consultation. Few respondents reported raising issues of reliability or sensitivity of the test with women, neither did they report discussing with women the possibility of an abnormal smear result or what further investigation and treatment may be required. The degree of persuasion reported by practitioners used to encourage women to attend for smears varied and was related to their attitudes to the national cervical screening programme. PRACTICE IMPLICATIONS: The current system for recall being separate from practice activity, whilst ensuring accuracy of the data-base, may limit the opportunity for information-giving which is sensitive to the needs to the local population. There is a need to include consent issues in the training of PNs, rather than just practical aspects of smear-taking, and to formalise training updates for GPs. In addition, the taking of opportunistic smears and the constraints placed upon time and information-giving need addressing. The role of other primary care staff in encouraging women to attend for smears raises training needs for these staff which practices or primary care trusts must address.

Attitude of Health Personnel↗
PubMed2005

Training professionals to engage with and promote self-management.

We have set out to investigate an approach to improve patients' ability to self-manage chronic illness. For effective health care in chronic disease, we believe patients need to work in partnership with their doctor; patient-centred consultations are one way to achieve this. This report describes our experience of training specialists in gastroenterology to consult in a patient-centred style as part of a complex self-management intervention in a randomized controlled trial (RCT) involving 700 patients with established inflammatory bowel disease (IBD) attending outpatient clinics. The training session aimed to provide specialists from nine randomly selected intervention sites with the basic skills to carry out the intervention. The training lasted 2 hours, and included background on the research and intervention, a demonstration video, role-play, and video-feedback training. The main findings of the RCT are presented (service use, enablement and satisfaction), and discussed in the light of the views of consultants and patients on the experience of putting the training into practice. The findings of our study confirm and highlight the value of training in patient-centred communication and its potential for promoting self-management effects; the training proved effective in enabling consultants in gastroenterology to establish guided self-management in patients with IBD.

Adolescent↗
PubMed2005

Housing improvement and self-reported mental distress among council estate residents.

This paper is concerned with how housing improvements instigated either publicly or privately influence the degree of psychological stress reported by council estate residents in South Manchester. Stress is measured on the GHQ12 scale containing standard symptomatic items. Potential sources of variation in this indicator are analysed within a geographical setting where repeated samples of residents were drawn from two adjacent suburban council housing estates before and after the implementation of a single regeneration budget (SRB) housing initiative in late 1999. The residents of one of these estates (Wythenshawe) were targeted by this funding while those in the other (Mersey Bank) were not. The latter, therefore, serve as a control for the effects of the enhanced incidence of housing improvement activity promoted by this SRB. Regression analyses revealed that stress was raised significantly among the SRB residents perhaps on account of the additional environmental nuisance they encountered. The experience of stress among all residents, however, was dominated by measures of personal psychosocial risk and it is argued that future regeneration initiatives should address the manifestation of these risks in the effort to achieve better mental health.

Adult↗
PubMed2005

Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals.

CONTEXT: Nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment. Although patient variables such as insight and symptoms that contribute toward attitudes have been identified, the contributions of relationship and service factors have not been adequately studied. OBJECTIVE: To determine relations between clinical and service variables and attitudes toward medication in people with a diagnosis of schizophrenia and schizoaffective disorder. DESIGN: Consecutively admitted patients were approached to take part; 23 refused. Measures included symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience. Data were analyzed by a proportional odds model and structural equation modeling to test predicted paths between experience of admission, relationship variables, attitudes toward treatment, and self-reported adherence to medication. SETTING: Twenty-eight inpatient wards at 8 hospitals in North Wales and the Northwest of England. Sites included hospitals with inner-city and rural catchment areas. Patients Two hundred twenty-eight patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder, assessed during acute admission. MAIN OUTCOME MEASURES: Attitudes toward treatment and self-reported adherence to medication. RESULTS: The data fit a model in which attitudes toward treatment were predicted by insight, relationship with staff (especially the physician-prescriber), and the patient's admission experience (maximum likelihood chi(2)(49) = 89.3, P<.001). A poor relationship with the prescriber, experience of coercion during admission, and low insight predicted a negative attitude toward treatment. CONCLUSIONS: The quality of relationships with clinicians during acute admission appears to be an important determinant of patients' attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.

Adolescent↗
PubMed2005

Dealing with it: Black Caribbean women's response to adversity and psychological distress associated with pregnancy, childbirth, and early motherhood.

This paper focuses on Black Caribbean women's ideas about perinatal depression and the ways in which these are linked to coping with personal adversity. An epidemiological survey found that despite higher levels of social risk among Black Caribbean women living in the UK, they were no more likely than White British women to record above-threshold depression scores postnatally and were significantly less likely to have done so during pregnancy. In-depth interviews were undertaken to illuminate the models, experiences, and meaning of perinatal depression held by Black Caribbean women. Women's narratives suggested that they rejected 'postnatal depression' as a central construct for understanding responses to psychological distress associated childbirth and early motherhood. Rejection of depression as illness was associated with imperatives to normalise distress and a self-concept which stressed the importance of being 'Strong-Black-Women' for maintaining psychological well-being. This identity served to reinforce notions of resilience, empowerment, and coping strategies characterised by the need to problem-solve practically, assertively, and materially. The study questions the utility of attaching psychiatric labels to the emotional and psychological distress experienced by Black Caribbean women around the perinatal period.

Adaptation, Psychological↗
PubMed2005

From patients to providers: prospects for self-care skills trainers in the National Health Service.

Changes in the National Health Service (NHS) workforce and user involvement have been key areas of contemporary health care policy. Potentially, the current separation of the agendas for patient participation and reconfiguration of the workforce are being brought closer together in the NHS through the Expert Patients Programme (EPP), and its potential to create a new community health 'workforce' of self-management and self-care skills trainers and tutors. The aim of the present paper is to assess the establishment and prospects of these trainers as a new workforce role in the EPP and the NHS. This is done through policy analysis and process evaluation recording the development and implementation of the EPP in the NHS. Telephone interviews with individual trainers were undertaken in order to identify the way in which they are being introduced into the NHS. A representative sample of 19 trainers from the 26 teams covering all the primary care trusts (PCTs) in England were interviewed. The EPP trainers are employed and appointed by the Department of Health and assist PCTs to run EPP courses. The analysis of trainer perspectives illuminated some of the tensions inherent in this new role, which emerge from the consequences of having a long-term condition, their relationship to other occupations operating within primary care and their structural position within the NHS. Prospects for the future development of self-management trainers remain uncertain. Two likely outcomes are examined. The first is that trainers and volunteer tutors will become increasingly integrated as a semi-professionalised group within the primary care workforce. The other option is for trainers to become freelance consultants commissioned by PCTs to run local self-management, self-care support or EPP programmes with the consequence of establishing a more distant relationship with mainstream NHS provision.

Female↗
PubMed2005

The troubled relationship between psychiatry and sociology.

The alienated relationship between psychiatry and sociology is explored. The two disciplines largely took divergent paths after 1970. On the one side, psychiatry manifested a pre-occupation with methodological questions and sought greater medical respectability, with a biomedical approach returning to the fore. Social psychiatry and its underpinning biopsychosocial model became increasingly marginalised and weakened. On the other side, many sociologists turned away from psychiatry and the epidemiological study of mental health problems and increasingly restricted their interest to social theory and qualitative research. An interdisciplinary void ensued, to the detriment of the investigation of social aspects of mental health.

Cooperative Behavior↗
PubMed2005

Uncovering the limits of patient-centeredness: implementing a self-management trial for chronic illness.

Research evaluating self-management of chronic conditions points to the effectiveness of interventions' changing the health behavior of individuals. However, we know little about how self-management is negotiated within health services. The authors designed a qualitative investigation to illuminate the quantitative findings of a randomized controlled trial (RCT) of a self-management program for people with inflammatory bowel disease. They conducted in-depth interviews with physicians and patients, and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation. The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people's self-management activities fully, interpretation of self-management as compliance with medical instructions, and the organization of outpatients' clinics. Giving attention to these barriers might maximize the opportunities for patient self-management of chronic illness based on a therapeutic alliance with health care professionals.

Adult↗
PubMed2004

Urban regeneration and mental health.

OBJECTIVE: The aim of this study was to assess the impact of an urban regeneration project on mental health. METHOD: A longitudinal study was made with 22-month follow-up in a Single Regeneration Budget area, and matched control area in South Manchester. A total of 1344 subjects responded to a postal questionnaire survey. The main outcome measures were GHQ12 (mental health) status, MANSA (Life satisfaction), and GP use. RESULTS: Mental health outcome in the index and control areas showed no improvement over time. Health satisfaction declined slightly in the index compared to the control area. GP use was unchanged. Restricted opportunities, a variable closely related to mental health, were not removed by the urban regeneration initiative. CONCLUSIONS: The urban regeneration initiative may have had little impact because it failed to address the concerns of local residents and failed to remove restricted opportunities, which appeared to be the key factor. A longer follow-up period may be required to demonstrate an effect.

England↗
PubMed2004

What if my back breaks? Making sense of musculoskeletal pain among South Asian and African-Caribbean people in the North West of England.

OBJECTIVES: The pain and disability, which arise as a result of musculoskeletal conditions, have been central to theories and understanding about chronic illness. However, little attention has been paid to the experience of such pain amongst ethnic minority groups. In this paper, we explore Asian and African-Caribbean respondents' ideas about the nature of and management of widespread pain. METHODS: Our data are drawn from a qualitative study linked to an epidemiological study of musculoskeletal symptoms undertaken in the North West of England. In-depth interviews were carried out with 32 people. Themes identified from the data were causes of symptoms, experience of pain, primary care utilisation and self-management. RESULTS: For both African-Caribbean and South Asian populations widespread pain was reported more frequently than a general population sample residing in the same locality. However, notions of the experience and management of widespread pain differed. Accounts of pain from the African-Caribbean respondents coincided with a traditional Western medical model of psychogenic pain and individualised coping strategies. Descriptions from some South Asian respondents suggested a lack of demarcation between pain located in specific parts of the body and broader social and personal concerns and an unwillingness to recognise the latter as "depression" or psychological distress. Help from family members was referred to more than individual strategies of managing pain. CONCLUSIONS: Differences in the experience of musculoskeletal has relevance for understanding the way in which psychosocial distress is manifested and managed in primary care.

Adaptation, Psychological↗
PubMed2004

Peoples' understandings of a primary care-based mental health self-help clinic.

Self-help programmes are increasingly advocated as a means of managing mental health problems. This qualitative study explored patients' understandings of the use of a UK primary care-based self-help clinic (facilitated by a nurse). As part of a wider evaluation of the clinic, in-depth interviews were conducted with a purposive sub-sample of clinic users. Data indicate that people understand their problem as one of having lost an ability to cope, and that the ethos underlying the clinic is well matched to restore a sense of coping, by motivating patients to re-establish and retain control over their everyday lives. However, some patients experienced a sense of dissonance between prior expectations and actual use of the self-help clinic. Without prior familiarity with self-help, engaging the patient as the mechanism of change may be difficult. Some patients expected formal counselling and were influenced in this by their previous experience of services and discussions with the GP at the point of referral. It takes time and active engagement with self-help materials before patients become aware that they are a crucial mechanism of change. Patients may benefit from information and a referral process, which emphasises the centrality of self-efficacy and the patient as 'change agent' prior to referral.

Adaptation, Psychological↗
PubMed2004

Perinatal depression among black Caribbean women.

The present paper describes findings from a mixed-method, longitudinal cohort study into perinatal depression among black Caribbean women. Using symptom scores from the Edinburgh Postnatal Depression Scale (EPDS), 101 black Caribbean and 200 white British women accessing maternity services in Manchester, UK, were screened for depressive symptoms in the last trimester of pregnancy and 6 weeks following delivery. The purpose of the study, which was undertaken between February 2000 and February 2001, was to estimate the prevalence of depressive symptoms during and after pregnancy among black Caribbean women compared to white British women in the same geographical area, and to explore black Caribbean women's beliefs about perinatal depression and their attitudes to help-seeking. Despite higher levels of self-reported risk, black Caribbean women were less likely than white British women to score above threshold (EPDS > or = 12) during pregnancy (chi2 = 4.16, d.f. = 1, P = 0.041). Although equally likely to score above threshold postnatally, they were less likely to receive treatment (chi2 = 4.20, d.f. = 1, P = 0.040) and more likely to be referred to secondary care (Fisher's Exact Test, P = 0.049). Qualitative findings suggest important differences between black Caribbean women's beliefs, attitudes and associated help-seeking practices, and those previously reported. Lower rates of depressive symptoms might partly be accounted for by conceptualisations of mental illness which differ from those of white British and South Asian women, and mistrust of the mental health services. This study showed that black Caribbean ethnicity is an important dimension in understanding the social patterning of mental illness. The findings have implications for the equitable provision of primary care services since black Caribbean women experienced depressive symptoms in pregnancy and early motherhood, but were less likely than their white British counterparts to receive treatment.

Adult↗
PubMed2004

Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts.

How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re-analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in relation to three kinds of chronic illness (menorrhagia; depression; and chronic low back pain/medically unexplained symptoms). We present a comparative analysis of (a). the moral evaluation of the patient (and judgements about the legitimacy of symptom presentation); (b). the possibilities of disposal; and (c). doctors' empathic responses to the patient, in each of these clinical cases. Our analysis defines some of the fundamental conditions through which general practitioners frame their relationships with patients presenting complex but sometimes diffuse combinations of 'social', 'psychological' and 'medical' symptoms. These are fundamental to, yet barely touched by, the increasingly voluminous literature on how doctors should interact with patients. Moving beyond the individual studies from which our data are drawn, we have outlined some of the highly complex and demanding features of what is often seen as routine and unrewarding medical work, and some of the key requirements for the local negotiation of patients' problems and their meanings (for both patients and doctors) in everyday general practice.

Attitude of Health Personnel↗