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Biomedical subjects

Anthony Scott

Publications and source records attributed to Anthony Scott.

16 recordsLinked to original sources
PubMed2006

Geographically differentiated pay in the labour market for nurses.

This novel application of spatial wage theory to health service labour markets analyses the competitiveness of nurse's pay and how this differs between local labour markets in Britain. A switching regression model is estimated to derive standardised spatial wage differentials (SSWDs) for nurses and their comparators. An SSWD gap is constructed and its relationship to vacancies estimated. A reduction in the gap in a local area is shown to result in an increase in the long-term vacancy rate for National Health Service (NHS) nurses. The competitiveness of nursing pay is shown to have a strong effect on the ability of the NHS to attract and retain nurses.

Adult↗
PubMed2006

Detection of myocardial scar by contrast-enhanced cardiac magnetic resonance imaging in patients with troponin-positive chest pain and minimal angiographic coronary artery disease.

Patients who present with chest pain and elevated serum troponin levels may have minimal angiographic coronary artery disease, leading to diagnostic confusion. We investigated patients with troponin-positive acute coronary syndromes and minimal coronary artery disease (CAD) using contrast-enhanced cardiac magnetic resonance imaging to assess for myocardial scar. Twenty-three patients (54 +/- 8 years of age) who presented with chest pain, high troponin I level, and minimal angiographic CAD were included. Patients with a clinical pericarditis/myocarditis, tachyarrhythmia at presentation, previous myocardial infarction, or an alternative explanation for increased troponin I level were excluded. Myocardial scar was assessed with delayed-enhancement inversion-recovery imaging after administration of gadolinium. Hyperenhancement consistent with myocardial scar was seen in 7 of 23 patients (30%) and was located primarily in the right coronary artery distribution. Peak troponin level, clinical characteristics, and volumetric parameters were similar in patients with or without hyperenhancement. One patient had mid-myocardial enhancement that suggested undiagnosed myocarditis. There was a linear relation between the mass of myocardial scar and peak serum troponin level. In follow-up, subsequent cardiac events were more frequent in patients with hyperenhancement (43% vs 12.5%). In conclusion, patients with troponin-positive acute coronary syndromes may have significant myocardial scar even when minimal CAD is found on angiography.

Adult↗
PubMed2006

Why do work patterns differ between men and women GPs?

PURPOSE: The purpose of this study was to explore gender differences in contractual commitments, job satisfaction and spouses' occupation among GP principals in NHS Scotland. DESIGN/METHODOLOGY/APPROACH: This paper is based on data provided by a self-completion, postal questionnaire survey. The response rate was 50 per cent. FINDINGS: Males worked more hours than females and were more likely to work out-of-hours. Females reported greater job satisfaction but only when they worked fewer hours. Females earned less than males but there were no gender differences in total household income. Both genders planned to retire at 59 years. More males would delay retirement if they could work part-time. More females than males were in dual-doctor households. Male respondents in dual-doctor households were more likely to have modified their working hours or career aspirations than males in other households. PRACTICAL IMPLICATIONS: The number of hours worked by GPs is in part determined by the occupation/earning power of their spouse. The number of women GPs is increasing and they are likely to continue to choose to work fewer hours than their male counterparts have done in the past. ORIGINALITY/VALUE: This study has attempted to incorporate spouse's occupation/income as a factor in the career choices of GPs in Scotland.

Adult↗
PubMed2005

Promotion to hospital consultant: regression analysis using NHS administrative data.

OBJECTIVES: To examine factors influencing promotion to hospital consultant. DESIGN: Multivariate logistic regression analysis of NHS administrative data between 1991 and 2000. SETTING: Hospitals in NHS Scotland. Population All registrars, senior registrars, and specialist registrars in Scotland. MAIN OUTCOME MEASURE: The proportion of doctors promoted to NHS consultant. RESULTS: Compared with doctors who graduated in Scotland, graduates from the rest of the United Kingdom and from overseas were less likely to be promoted to consultant (odds ratio 0.65, 95% confidence interval 0.52 to 0.82; and 0.37, 0.28 to 0.50, respectively). Promotion and holding an honorary contract before promotion were positively associated (1.37, 1.03 to 1.83); and the number of years since graduation (5.98 per year, 4.94 to 7.23). Women were less likely to be promoted (0.73, 0.60 to 0.90), as were doctors who worked part time (0.27, 0.17 to 0.42). Probabilities of promotion did not have a clear time trend between 1993 and 2000, and NHS boards in non-metropolitan areas of Scotland were more likely to offer promotions than NHS boards in metropolitan areas, presumably reflecting a higher gap between demand and supply in these boards. CONCLUSION: As the proportion of women in hospital medicine increases, government targets for the recruitment of consultants are unlikely to be met unless the promotion process is examined. It is unclear whether more recent reforms of the medical career structure will deal with these issues.

Career Mobility↗
PubMed2005

A managed clinical network for cardiac services: set-up, operation and impact on patient care.

PURPOSE: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. METHODS: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. RESULTS: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference in resource use. DISCUSSION AND CONCLUSIONS: The Managed Clinical Network made a difference to ways of working, particularly in breaching traditional boundaries and involving the public, and made modest changes in patient care. However, it required a two-year "set-up" period. Managed clinical networks are complex initiatives with an increasing profile in health care policy. This study suggests that they require energetic leadership and improvements are likely to be slow and incremental.

Journal Article↗
PubMed2005

General practitioner non-principals benefit from flexible working.

PURPOSE: The purpose of this study is to explore non-principals' working patterns and attitudes to work. DESIGN/METHODOLOGY/APPROACH: The article is based on data provided by a questionnaire survey. Findings - Gender division was apparent among the non-principals. Males were more likely to work full-time, because their spouses modified their working hours. RESEARCH LIMITATIONS/IMPLICATIONS: It was impossible to identify all non-principals in Scotland or to compare responders and non-responders, due to the lack of official data. Hence, the results might not be representative. PRACTICAL IMPLICATIONS: More flexible posts would enable GPs to more easily combine paid work with family commitments. It is anticipated that the new GP contract should deliver this. ORIGINALITY/VALUE: This was the first time a study of all non-principals in Scotland had been attempted. The findings provide a more comprehensive picture of GPs in Scotland and provide valuable information for policymakers.

Adult↗
PubMed2005

Integrated primary care organizations: to what extent is integration occurring and why?

Integration in primary health care is occurring in many health-care systems without a clear understanding of the meaning of integration, its form and rationale. This literature review examines the definition and extent of integration, as well as the factors that might encourage it in the context of British integrated primary care organizations (IPCOs). Integration is complex and multifaceted. No commonly agreed definitions of integration have been developed and the range of dimensions examined in the empirical literature was limited. However, some of the dimensions examined in studies of IPCOs may be useful in better understanding the form integration takes. Few studies were designed to examine the determinants of integration or were explicitly based on theory. Research showed that the level of production and transaction costs was not related to the size of the IPCO, although in practice the attitudes of health professionals are likely to be more important influences on the extent of integration. To date, little progress has been made in explaining and measuring integration. If further integration in primary health care is warranted, more research is required to understand its nature, form and rationale.

Delivery of Health Care, Integrated↗
PubMed2004

Voluntary or compulsory health care reform? The case of primary care organisations in Scotland.

Previous studies have suggested that voluntary reform of the delivery of primary care services is more likely to occur in affluent areas. Health system reforms that include voluntary participation of GPs may therefore lead to a two-tier service in terms of access to and utilisation of medical services. New primary care organisations in Scotland (local health care co-operatives) were introduced in 1999. These are groups of general practices and membership was voluntary. The aim of this study is to examine whether the voluntary nature of membership was likely to exacerbate or reduce inequalities in the provision of primary care services. Logistic regression analysis was used to identify differences in population, practice, and GP characteristics between general practices that have joined a co-operative and those that have not. The results indicated that practices located in deprived areas and covering populations with high levels of morbidity were more likely to join a co-operative. High workload decreased the probability of membership. General practices that found it difficult to obtain access to local authority residential care homes were more likely to join a co-operative. The number of fee claims for minor surgery sessions per whole-time equivalent GP increased the probability of membership. There is therefore some evidence indicating that general practices located in areas of high need are more likely to join a co-operative. This suggests that voluntary participation in these new primary care organisations may reduce rather than exacerbate inequalities in the provision of primary care.

Community Networks↗
PubMed2004

Preferences for general practice jobs: a survey of principals and sessional GPs.

BACKGROUND: Many countries are experiencing recruitment and retention problems in general practice, particularly in rural areas. In the United Kingdom (UK), recent contractual changes aim to address general practitioner (GP) recruitment and retention difficulties. However, the evidence base for their impact is limited, and preference differences between principals and sessional GPs (previously called non-principals) are insufficiently explored. AIM: To elicit GP principals' and sessional GPs' preferences for alternative jobs in general practice, and to identify the most important work attributes. DESIGN OF STUDY: A discrete choice experiment. SETTING: National Health Service (NHS) general practices throughout Scotland. METHOD: A postal questionnaire was sent to 1862 principals and 712 sessional GPs. The questionnaire contained a discrete choice experiment to quantify GPs' preferences for different job attributes. RESULTS: A response rate of 49% (904/1862) was achieved for principals and 54% (388/712) for sessional GPs. Of responders, most principals were male (60%), and sessional GPs female (75%), with the average age being 42 years. All GPs preferred a job with longer consultations, no increase in working hours, but an increase in earnings. A job with outside commitments (for example, a health board or hospital) was preferable; one with additional out-of-hours work was less preferable. Sessional GPs placed a lower value on consultation length, were less worried about hours of work, and a job offering sufficient continuing professional development was less important. CONCLUSION: The differences in preferences between principals and sessional GPs, and also between different personal characteristics, suggests that a general contract could fail to cater for all GPs. Recruitment and retention of GPs may improve if the least preferred aspects of their jobs are changed. However, the long-term success of contractual reform will require enhancement of the positive aspects of working, such as patient contact.

Adult↗
PubMed2003

What do hospital consultants value about their jobs? A discrete choice experiment.

OBJECTIVE: To examine the strength of hospital consultants' preferences for various aspects of their work. DESIGN: Questionnaire survey including a discrete choice experiment. SETTING: NHS Scotland. PARTICIPANTS: 2923 hospital consultants in Scotland. MAIN OUTCOME MEASURES: Monetary valuations or prices for each job characteristic, based on consultants' willingness to pay and willingness to accept extra income for a change in each job characteristic, calculated from regression coefficients. RESULTS: The response rate was 61% (1793 respondents). Being on call was the most important attribute, as consultants would need to be compensated up to pound 18,000 (30% of their average net income) (P < 0.001) for a high on-call workload. Compensation of up to pound 9700 (16% of their net income) (P < 0.001) would be required for consultants to forgo opportunities to undertake non-NHS work. Consultants would be willing to accept pound 7000 (12% of net income) (P < 0.001) in compensation for fair rather than good working relationships with staff, and pound 6500 (11% of net income) (P < 0.001) to compensate them for a shortage of staff. The least important characteristic was hours of work, with pound 562 per year (0.9% of their net income) (P < 0.001) required to induce consultants to work one extra hour per week. These preferences also varied among specific subgroups of consultants. CONCLUSIONS: Important information on consultants' strength of preferences for characteristics of their job should be used to help to address recruitment and retention problems. Consultants would require increased payment to cover more intensive on-call commitments. Other aspects of working conditions would require smaller increases.

Consultants↗
PubMed2003

The labour market for nursing: a review of the labour supply literature.

The need to ensure adequate numbers of motivated health professionals is at the forefront of the modernisation of the UK NHS. The aim of this paper is to assess current understanding of the labour supply behaviour of nurses, and to propose an agenda for further research. In particular, the paper reviews American and British economics literature that focuses on empirical econometric studies based on the classical static labour supply model. American research could be classified into first generation, second generation and recent empirical evidence. Advances in methods mirror those in the general labour economics literature, and include the use of limited dependent variable models and the treatment of sample selection issues. However, there is considerable variation in results, which depends on the methods used, particularly on the effect of wages. Only one study was found that used UK data, although other studies examined the determinants of turnover, quit rates and job satisfaction. The agenda for further empirical research includes the analysis of discontinuities in the labour supply function, the relative importance of pecuniary and non-pecuniary job characteristics, and the application of dynamic and family labour supply models to nursing research. Such research is crucial to the development of evidence-based policies.

Health Workforce↗
PubMed2003

Eliciting preferences of the community for out of hours care provided by general practitioners: a stated preference discrete choice experiment.

Access to primary care services is a major issue as new models of delivering primary care continue develop in many countries. Major changes to out of hours care provided by general practitioners (GPs) were made in the UK in 1995. These were designed in response to low morale and job dissatisfaction of GPs, rather than in response to patients' preferences. The aim of this study is to elicit the preferences of patients and the community for different models of GP out of hours care. A questionnaire was sent to parents of children in Aberdeen and Glasgow in Scotland who had received a home visit or attended a primary care emergency centre, or were registered with a GP. The questionnaire used a discrete choice experiment that asked parents to imagine their child had respiratory symptoms. Parents were then asked to choose between a series of pairs of scenarios, with each scenario describing a different model of out of hours care. Each model varied by waiting time, who was seen, location, and whether the doctor listened. The response rate was 68% (3,893/5,718). The most important attribute was whether the doctor seemed to listen, suggesting that policies aimed at improving doctor-patient communication will lead to the largest improvements in utility. The most preferred location of care was a hospital accident and emergency department. This suggests that new models of primary care emergency centres may not reduce the demand for accident and emergency visits from this group of patients in urban areas. Preferences also differed across sub-groups of patients. Those who had never used out of hours care before had stronger preferences for waiting time and the doctor listening, suggesting higher expectations of non-users. Further research is required into the demand for out of hours care as new models of care become established.

After-Hours Care↗
PubMed2003

How are Scottish integrated primary care organisations managed?

In the absence of central guidance on the development of integrated primary care organisations, a diversity of models is emerging. This paper examines the management arrangements of Scottish local health care co-operatives (LHCCs). A postal questionnaire survey of all 79 LHCCs was conducted. The response rate was 35 per cent. LHCCs set up management bodies and created workgroups. Stakeholder representation was not socially inclusive: attempts to engage patients and local communities were limited and need to be stepped up to increase responsiveness and accountability to local health care users. LHCCs were also vehicles for local ownership and control of health care provision. To facilitate co-operation among participating practices, LHCCs need to focus on issues of leadership, organisation, and involvement in decision making. Finally, management expenditure per capita was comparable with that of other types of integrated primary care organisations.

Delivery of Health Care, Integrated↗
PubMed2002

Ultrasound scanning by general practitioners: is it worthwhile?

BACKGROUND: There are several alternatives for providing ultrasound scanning, besides traditional hospital-based services. One such alternative is for general practitioners (GPs) to perform scanning in the community. The aim of this study was to evaluate the impact of GP ultrasound scanning on the use of National Health Service (NHS) resources in the United Kingdom (UK), and elicit patients' preferences for having an ultrasound scan. METHODS: A cost analysis and an assessment of quality of GP scans, based on a clinical audit and a postal survey of patients' preferences, were carried out. The setting was a rural general practice and urban teaching hospital in the Grampian region of Scotland. The analysis of costs and assessment of the quality of GP scans were based on 131 patients scanned at the practice in a 6 month clinical audit period. The survey of patients' preferences was undertaken on a random sample of 500 patients from the GPs' list and 250 consecutive patients scanned at the practice. RESULTS: The assessment of the management of patients during audit revealed that the scanner at the practice reduced the number of hospital scans, number of out-patient and in-patient visits, and emergency admissions. The unit cost of a scan was higher in the practice than at the hospital. However, when all the costs for a scanning episode were considered, the total and average costs were lower in the practice because of the avoidance of hospital visits. The results showed that the quality of GP scanning, subject to further training, was considered to be sufficient to continue scanning at the practice. Patients preferred to be scanned at the practice, and were prepared to wait up to an extra 5 days, and accept a reduction in the accuracy of scanning of up to 3.5 per cent for their choice. Who carried out the scan was not important to patients. CONCLUSION: Although the results of the study provide some evidence to support GP scanning in this setting, further research on diagnostic accuracy and alternative models of care need to be conducted.

Clinical Competence↗
PubMed2002

Economic approaches to doctor/nurse skill mix: problems, pitfalls, and partial solutions.

Against a background of government calls for a radical change in the way the medical workforce is planned and trained, the concept of skill mix seeks to match clinical presentation to an intervention based on an appropriate level of skill and training. Health economics is not the only framework within which these changes can be analysed. However unless the economic issues are thought through clearly there is a danger that resources may be used inefficiently. The aims of this paper are to outline the economic issues in the area of doctor/nurse skill mix and the problems of obtaining correct solutions from the perspective of efficiency. It concludes by offering a pragmatic framework which can facilitate decisions in this area. Although this paper is written from the perspective of primary care, it is equally relevant to skill mix in the secondary care sector.

Clinical Competence↗