Biomedical subjects
B Jarman
Publications and source records attributed to B Jarman.
Primary health care in London--changes since the Acheson report.
OBJECTIVE: To examine changes in primary care in London in the 11 years since the Acheson report on primary health care in inner London. DESIGN: Analysis of key data from the family health services authority performance indicators and from the Department of Health; study of trends since the time of the Acheson report; examination of the provision of primary care in 1990-1 and its relation to health and social factors. SETTING: Comparisons between the family health services authorities of inner London, outer London, and England as a whole, with a special study of Birmingham, Liverpool, and Manchester. SUBJECTS: The family health services authorities of England. RESULTS: There has been an improvement in the provision of primary care in inner London as judged by the criteria of the Acheson report, but these improvements have occurred only as part of an overall improvement in the provision of primary care in the country as a whole. None of the recommendations of the Acheson report specifically oriented to London have been implemented. There are some worrying trends in inner London, such as the increasing proportion of practices with more than 2500 patients. The problems faced by practitioners in inner London resemble those in other large inner city areas, but the primary care provision to deal with them is relatively poor.
Predicting psychiatric admission rates.
OBJECTIVE: To determine the numbers of actual and expected psychiatric admissions for the residents of the district health authorities of England and to develop a model to indicate which social, health status, and service provision factors best explain the variation of the actual from the expected psychiatric admissions; to use this model to predict psychiatric admission for district health authorities as an aid to resource allocation. DESIGN: The actual psychiatric admission for district health authority residents were extracted from data of the 1986 Mental Health Enquiry. Expected admissions were calculated using the age, sex, and marital status structure of each district health authority and the national psychiatric admission rates related to age, sex, and marital status. Standardised psychiatric admission ratios were calculated as the ratios of the numbers of actual to expected psychiatric admissions. A wide range of social, health status, and service provision data were used as the explanatory variables in regression analyses to determine which combination of factors best explained the variation between districts of standardised psychiatric admission ratios. SETTING: The 168,652 psychiatric admissions recorded for the 1986 Mental Health Enquiry, after exclusion of mental handicap and psychogeriatric admissions. RESULTS: The actual number of psychiatric admissions varied from 79% above to 54% below the expected number of admissions from age, sex, and marital status for the districts of England. The most powerful variables to explain this variation were the rate of notification of drug misusers, standardised mortality ratios, and levels of illegitimacy in each district. A complex model was developed which could be used to predict district psychiatric admissions as an aid to resource allocation. A simpler model was also developed (which was less powerful than the more complex model) based on the underprivileged area score. One advantage of this model was that it could be used at the level of electoral wards as well as district health authorities.
Care plans for the operating department.
Very little, if any, of the care administered by the theatre staff within operating theatres has ever been fully documented. The person 'scrubbed' for the case and the circulating person accountable for the final swab, instrument and needle checks, sign their names in a ledger within theatre. A verbal exchange relating to the patient's operation, the dressings applied, any drains or implants in situ etc. may take place between the 'scub' person and the nurse into whose care the patient is to be entrusted. It is little wonder that we in theatres appear to have lost our identity as nurses and the role envisaged by our colleagues is one of a technician or that of being the surgeon's 'hand-maiden'! As stated in a previous Journal, 'The failure to define the nurse's role in the theatre can only mean one of two things--either nursing is not clearly demonstrated by theatre nurses or nursing does not exist within operating theatres'.
Research for the review of RAWP.
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Unemployment rates: an alternative to the Jarman index?
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Jarman index.
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James Mackenzie lecture 1990. General practice, the NHS review and social deprivation.
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Ethnic differences in consultation rates in urban general practice.
OBJECTIVE: To determine the patterns of consultations with the general practitioner among different ethnic groups and the outcome of these consultations. DESIGN: Retrospective analysis of data from one urban group general practice collected during 1979-81 as part of a research project in seven practices. SETTING: Group general practice in the London borough of Brent with a list size of 10,877 patients in July 1980. SUBJECTS: Patients registered with the practice during the 23 months to April 1981 who accounted for 67,197 consultations. MAIN OUTCOME MEASURES: Ethnic state, sex and social class distribution, and diagnosis of patients consulting and frequency of consultations analysed as standardised consultation ratios and standardised patient consultation ratios. RESULTS: Compared with other ethnic groups male Asians (that is, including those born in Britain and those originating from the Indian subcontinent and east Africa) had a substantially increased standardised patient consultation ratio. Consultation rates for mental disorders--in particular, anxiety and depression--were reduced in all groups of immigrant descent. West Indians consulted more frequently for hypertension and asthma, and their children less frequently with otitis media. Asians consulted more frequently with upper respiratory tract infections and non-specific symptoms. Native British patients were more likely to leave the surgery with a follow up appointment, prescription, or certificate. CONCLUSION: Notwithstanding the limitations of this study, ethnic differences in consultation rates were apparent. These differences require further investigation if the needs of minority ethnic groups are not to be overlooked.
Theatre experience: a useful tool for recruitment?
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Uptake of immunisation in district health authorities in England.
The uptakes of immunisation in the district health authorities in England were studied for the years 1983-5. Multiple regression analysis showed that the factors significantly associated with a low uptake of immunisation were mainly related to social conditions, particularly overcrowding of households and population density. Of the service factors, high proportions of elderly and singlehanded general practitioners and high average list sizes were also associated with a low uptake of immunisation in some of the analyses. The results suggest that the measures outlined in the government's white paper on improving primary health care services are likely to lead to improved uptakes of immunisation. If, however, the uptakes of immunisation are used as a measure of standards of the services provided they should first be adjusted to control for variations in social conditions, and the quality of vaccination data would have to be improved.
Developing primary health care.
Primary health care is best provided by a primary health care team of general practitioners, community nurses, and other staff working together from good premises and looking after the population registered with the practice. It encourages personal and continuing care of patients and good communication among the members of the team. Efforts should be made to foster this model of primary care where possible and also to evaluate its effectiveness. Community services that are not provided by primary care teams should be organised on a defined geographical basis, and the boundaries of these services should coincide as much as possible. Such arrangements would facilitate effective community care and health promotion and can be organised to work well with primary care teams. The patient's right to freedom of choice of a doctor, however, should be retained, as it adds flexibility to the rigidity of fixed geographically based services.
Patterns of physicians' use of medical resources in ambulatory settings.
We studied British general practitioners' use of ambulatory resources to determine whether the quantities of different resources used were related to each other, and whether these quantities were associated with their personal characteristics. Rates of laboratory requests, referrals for specialty opinion, prescriptions, and visits per patient per year were examined for 21 physicians in seven practices over one year. Physicians who more frequently saw their patients referred and prescribed for them more often and ordered more tests, once the number of years they had practiced was taken into account. Doctors who ordered more tests referred their patients more frequently, regardless of how often they saw them. Doctors longer in practice saw and prescribed for their patients more frequently. Resource use was not related to other personal characteristics we studied. Greater frequency of patient-physician contact appears to increase costs not only through use of more professional time but also through greater use of other ambulatory resources. Attention to the use of only one type of resource may result in a distorted picture of how physicians care for their patients and the costs that such care incurs.
Quality in general practice: a focus on inner cities.
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