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Biomedical subjects

C R Victor

Publications and source records attributed to C R Victor.

At least 37 records · Page 2Linked to original sources
PubMed1991

Low immunization uptake rates in an inner-city health district: fact or fiction?

Immunization uptake rates are assuming considerable importance as performance indicators for district health authorities (DHAs) and general practitioners (GPs). Data from the Cover of Vaccination Evaluated Rapidly (COVER) programme suggest that immunization uptake rates in innercity districts are well below the 90 per cent target. Using Parkside DHA, a district with consistently poor uptake, as an example, this paper has examined the accuracy of the Child Health Computer (CHC) records on which the COVER figures are based. In October 1989 a cohort of 1485 children born between April and June 1988 were identified. The 462 children identified by the CHC as immunization defaulters (using diphtheria and tetanus immunizations) were followed up by contacting child health clinics, GP surgeries and parents. This exercise revealed that 195 children were in fact immunized and 176 children were erroneously listed, largely because they were no longer resident at the address given. Only a small proportion of this information had reached the CHC by the end of the follow-up period. In addition to high population mobility, information inaccuracies appeared to be caused partly by a failure in data transfer between GPs and the DHA and by failures in data transfer between districts. Overall, the results of the study suggest that there is a considerable discrepancy between actual and recorded immunization uptake levels in Parkside and probably other inner-city areas. This will have a considerable impact on GPs and other health professionals who are striving to achieve 90 per cent targets.

Child Welfare↗
PubMed1990

Developing care in the community: GPs and the HIV epidemic.

Services for HIV infection and AIDS in Parkside DHA have been largely hospital based with little active involvement of local GPs. In response to the wishes of those with HIV/AIDS and predicted increases in the number of patients the DHA is now developing an AIDS strategy which identifies the development of primary and community care as a major objective. A postal survey of all 263 GPs within the DHA was undertaken in order to ascertain their views about the role of primary care in the management of HIV infection/AIDS. Replies were received from 75% (196). The responses to the survey indicated both the potential of general practice and willingness of GPs to be involved in the care of this client group. However, two key issues in developing this strategy were identified. These were information exchange and confidentiality. It is suggested that both hospitals and general practice must develop rigorous confidentiality policies to overcome these difficulties.

Communication↗
PubMed1989

Use of hospital services by homeless families in an inner London health district.

Over the past decade the number of families in London who were considered officially to be homeless appreciably increased. In response to this many families have been given temporary accommodation, usually in bed and breakfast hotels, while awaiting permanent rehousing. About 200 of the roughly 600 hotels in London that provide such accommodation are located in the area of the former Paddington and North Kensington Health Authority, now part of Parkside Health Authority. The use made by the homeless population of hospital services was studied by finding out the numbers of inpatients admitted to hospital and the numbers presenting to the walk in paediatric clinic and the casualty department at one hospital. These figures were compared with those for local residents and the overall workload. The bed and breakfast population were high users of inpatient beds, the casualty department, and the paediatric clinic. Overall, about one tenth of the beds were used by these people. The health authority receives no additional funding for this group of patients. Further research is needed to find out if the high use of hospital services made by these patients reflects their increased morbidity or their inability to obtain primary care services.

Catchment Area, Health↗
PubMed1989

Measuring outcome after discharge from hospital for the elderly--a conceptual and empirical investigation.

Despite the fact that the elderly are a major client group of the hospital service, there has been comparatively little investigation of outcome for this client group after discharge. In this paper the difficulties in recording outcome for the elderly are discussed, using the example of a survey based in Wales. A 4% random sample of patients aged 65 years and over discharged from NHS non-psychiatric hospitals in Wales during 1981 were sent a postal questionnaire 3 months after discharge. Response rates of over 80% were achieved. Outcome after discharge was measured by 3 indices: mortality, physical disability, and patients' own assessments of their health status and rehabilitation. Of survivors, 35% were more disabled than before admission, and 43% did not feel that they were fully rehabilitated. All measures of outcome were strongly inter-correlated and demonstrate a clear trend to deteriorate with increased time after discharge. Interpretation of these results remains difficult until measures of cost and benefit are developed. Without these it is not possible to determine if the results reported are better (or worse) than would be expected given the level of resources involved.

Activities of Daily Living↗
PubMed1989

Inequalities in health in later life.

Older age groups are usually omitted from studies of inequalities in health on account of the widespread assumption that later life is a time of universal ill health which will obscure the differences apparent at earlier ages. Data from the 1980 General Household Survey reveal significant social class and sex differences among elderly people in the prevalence of chronic illness and in perceived health status. These findings show that the experience of health in later life is related to social circumstances.

Age Factors↗
PubMed1988

Rearranging the deckchairs on the Titanic: failure of an augmented home help scheme after discharge to reduce the length of stay in hospital.

An augmented home help service was set up in the Rhondda Valley in South Wales in order to facilitate discharge from hospital of elderly subjects who were kept in hospital because of mainly social problems. Patients were allocated to the new service or the pre-existing services according to their date of birth. The extra social support did not result in a faster discharge from hospital, nor in any improvement in well-being of the intervention group, largely because the small extra amount of service input was inadequate to ameliorate the extreme physical, mental and social problems experienced by the study group.

Aftercare↗
PubMed1988

Some methodological aspects of using postal questionnaires with the elderly.

Postal questionnaires are not usually recommended for use with the elderly. This paper describes a methodological study of the use of a postal questionnaire as a method of data collection with older subjects. In particular the problems of generating an adequate response rate, of non-response bias and response quality are addressed. It is shown that postal questionnaires can generate response rates in excess of 80% with older subjects. Questionnaire length was not associated with response rate. Non-response was highest amongst the older age groups suggesting that this method of data collection is subject to non-response bias, thereby understanding the effects of age. The format of question presentation was associated with both response rate and response quality. It is concluded that postal questionnaires are a useful and cost-effective way of collecting survey data from older subjects. In particular such techniques may be effectively employed as a method of routinely screening older people living in the community.

Aged↗
PubMed1988

Preparing the elderly for discharge from hospital: a neglected aspect of patient care?

People aged 65 years and over are the largest consumer group of hospital care, and an important element of their treatment is the transfer back into the community. Preparation and planning for discharge is, therefore, an integral aspect of the care of older people in hospital. This study used a random sample of people aged 65 and over discharged from hospitals throughout Wales to investigate, by the use of a postal questionnaire, the preparation they had received for their discharge whilst in hospital. Preparation for discharge was defined as length of notice of impending discharge and discussions with staff about their return home. A response rate of over 80% was obtained to the questionnaire. Thirty-nine per cent of the sample were given less than 24 h notice of discharge and less than 50% reported that a member of the hospital staff discussed their discharge/return home with them whilst in hospital. Discharge planning/preparation was very much better amongst patients seen in geriatric medicine compared with those seen in other specialties. It is concluded that, with the exception of geriatric medicine, discharge planning for the elderly remains a very neglected aspect of patient care.

Age Factors↗
PubMed1988

End of an experiment: report from an inner city community hospital.

Community hospitals are associated with the provision of health care in rural rather than urban areas. However, the urban community hospital can reduce the pressure on acute hospitals and decrease the isolation of community health workers. In 1982 a community hospital was established in an inner London health district. This paper examines the role and function of this hospital over a oneyear period in 1986-87 and makes comparisons with the hospital's first two years of operation. The problems identified in the initial evaluation, such as low bed occupancy and the limited participation by general practitioners in the area, were still present. It was found that there had been a decrease in the number of patients treated for musculoskeletal, nervous system and respiratory problems but an increase in circulatory disorders and injuries or poisoning. There was also a marked decrease in the percentage of acute admissions but an increase in admissions for convalescence, rehabilitation and carer relief. Following a severe financial crisis in the health district the hospital was closed temporarily in November 1987.

Attitude of Health Personnel↗
PubMed1987

The relationship between the receipt of supplementary pension, disability and the use of services by the elderly.

Twelve hundred and eighty-eight people aged 70 and over in two general practices in South Wales were interviewed about their degree of physical disability, their use of health and social services and whether or not they received supplementary pensions. Those who received supplementary pensions were more likely to be in receipt of services at all levels of physical disability but a multiple regression analysis suggested that this was due to intervening variables, particularly the degree of physical disability and whether or not the person lived alone.

Aged↗
PubMed1986

A health visitor affects the problems others do not reach.

Difficulties associated with old age that were previously unknown to the general practitioner were detected by a health visitor attached to a general practice for 2 years and given a case-load of 296 people aged 70 years or more. Previously unknown conditions included physical and mental illnesses and social difficulties related to the patient's environmental setting or to the person (carers) who looked after the patient regularly. Most of the severe illnesses were known to the general practitioner but many minor ailments and other aspects of old age were not. Even though the practice had a policy of encouraging doctors to visit the elderly in their homes, the health visitor was more successful at obtaining a complete picture of old people's home circumstances and the consequences of them.

Adjustment Disorders↗
PubMed1986

A survey of elderly patients admitted to hospital for social reasons.

A random 4% sample of the over 65's discharged from general hospitals throughout Wales was selected from Welsh Office HAA returns. Included within the group were 101 patients admitted for social reasons (ICD code V600 to V6055). Such patients were predominantly very elderly, female and extremely disabled. Typically such patients lived with, and were being cared for, by relatives. The majority of admissions were booked or planned to provide relief to these carers. Geographical variations in the use of such care was demonstrated. Use of domiciliary medical services by these patients was extremely high in contrast to their use of domiciliary social services. Mortality and re-admission rates at 3 months and 12 months after the initial discharge were very high and hospital treatment had little influence upon patients' disability. However, the short mean length of stay suggests that such patients do not 'block beds'.

Aged↗
PubMed1986

Poverty, disability and use of services by the elderly: analysis of the 1980 General Household Survey.

Poverty is one of the most distinctive features of old age in Britain. At least half the population aged over 65 live in, or on the margins of, poverty. Old age is also characterized by a decrease in functional capacity and an increase in use of statutory social and health services. However the inter-links between poverty, disability and use of services have not been well researched. In this paper we examine these inter-relationships using data derived from the 1980 General Household Survey.

Aged↗
PubMed1985

Use of medications on the restricted list by the elderly.

On 1 April 1985 the range of drugs that may be prescribed on the National Health Service was limited by the government. We studied the possible effects of this new policy on 1066 elderly patients in two general practices in south Wales. Many patients who were prescribed drugs from the restricted list were also disabled, had psychological problems, or were on supplementary pension. We intend later this year to study the consequences of the changes in prescribing on elderly patients.

Aged↗
PubMed1985

A one-year follow-up of patients discharged from geriatrics and general medical units in Wales.

A random sample of patients aged 65 yr and over, admitted as emergencies to the specialties of geriatrics and general medicine in Wales were interviewed 3 and 12 mth after discharge using a postal questionnaire. The characteristics of patients, the preparation they received for discharge and the use made of community services were recorded as were mortality, functional capacity and rehabilitation. Overall geriatrics patients were better prepared for discharge, were given a higher level of service provision and had a more favourable outcome than the general medical patients.

Aged↗