PubMed Health⌕ Search

Biomedical subjects

Colin Sanderson

Publications and source records attributed to Colin Sanderson.

7 recordsLinked to original sources
PubMed2006

Patients' own assessments of quality of primary care compared with objective records based measures of technical quality of care: cross sectional study.

OBJECTIVE: To investigate the relation between older patients' assessments of the quality of their primary care and measures of good clinical practice on the basis of data from administrative and clinical records. DESIGN: Cross sectional population based study using the general practice assessment survey. SETTING: 18 general practices in the Basildon primary care trust area, south east England. PARTICIPANTS: 3487 people aged 65 or more. MAIN OUTCOME MEASURES: Correlations between mean practice scores on the general practice assessment survey and three evidence based measures on survey of case records (monitoring for, and control of, hypertension, and vaccination against influenza). RESULTS: 76% of people (3487/4563) responded to the general practice assessment survey. Correlations between patient assessed survey scores for technical quality and the objective records based measures of good clinical practice were 0.22 (95% confidence interval -0.28 to 0.62) for hypertension monitored, 0.30 (-0.19 to 0.67) for hypertension controlled, and -0.05 (-0.50 to 0.43) for influenza vaccination. CONCLUSIONS: Older patients' assessments are not a sufficient basis for assessing the technical quality of their primary care. For an overall assessment both patient based and records based measures are required.

Age Distribution↗
PubMed2006

A comparison of formal consensus methods used for developing clinical guidelines.

OBJECTIVES: To compare two consensus development methods commonly used for developing clinical guidelines in terms of the judgments produced, closeness of consensus, amount of change between rounds, concordance with research evidence and reliability. METHODS: In all, 213 general practitioners and mental health professionals from England participated in four Delphi and four nominal groups. They rated the appropriateness of four treatments (cognitive behavioural therapy [CBT], behavioural therapy [BT], brief psychodynamic interpersonal therapy [BPIT] and antidepressants) for three conditions. First, participants rated the appropriateness of interventions independently, using a postal questionnaire. For nominal groups, the ratings were fed back and discussed at a meeting, and then group members privately completed the questionnaire again. For Delphi groups, there was feedback but no discussion, and the entire process was conducted by postal questionnaire. RESULTS: The effect of consensus method on final ratings varied with therapeutic intervention, with nominal groups rating CBT and antidepressants more favourably than Delphi groups. Consensus was closer in the nominal than in the Delphi groups in both rounds. There was no overall difference between groups in their concordance with research evidence (odds ratio 1.13, 95% confidence interval 0.79-1.61). In this study, the Delphi method was more reliable (kappa coefficients 0.88 and 0.89 compared with 0.41 and 0.65 for nominal groups). CONCLUSIONS: The advantages of nominal groups (more consensus; greater understanding of reasons for disagreement) could be combined with the greater reliability of the Delphi approach by developing a hybrid method.

Chronic Disease↗
PubMed2002

The development of a simulation model of primary prevention strategies for coronary heart disease.

This paper describes the present state of development of a discrete-event micro-simulation model for coronary heart disease prevention. The model is intended to support health policy makers in assessing the impacts on health care resources of different primary prevention strategies. For each person, a set of times to disease events, conditional on the individual's risk factor profile, is sampled from a set of probability distributions that are derived from a new analysis of the Framingham cohort study on coronary heart disease. Methods used to model changes in behavioural and physiological risk factors are discussed and a description of the simulation logic is given. The model incorporates POST (Patient Oriented Simulation Technique) simulation routines.

Computer Simulation↗
PubMed2002

[Using different indicators of preventable mortality as an approach to measuring health inequalities in Chilean municipalities].

OBJECTIVES: To analyze differences in avoidable mortality among communes in Chile, using different indicators as an operational approach to estimating health inequalities. METHODS: Small area variation analysis in a sample of 117 of all 335 Chilean communes that existed in 1992. By using secondary data, we developed and compared some avoidable-mortality indicators, such as potential years of life lost (PYLL), avoidable mortality (AM) (based on background and criteria drawn from the literature), health care avoidable mortality (HCAMR), and life expectancy. A socioeconomic development index (SEDI) was also developed. The scope of the variation was estimated through the weighted variation coefficient, the Gini coefficient, the ratio between the values for the quintiles at both extremes of the SEDI distribution, and the ratio of the lowest SEDI quintile to the group of municipalities having a SEDI greater than 0.90 (optimal empirical reference value). The socioeconomic pattern of variations was examined through concentration curves and by comparing communal quintiles based on their SEDI. RESULTS: The various avoidable-mortality indicators used showed an inverse and statistically significant correlation with socioeconomic development, as well as with the profile of the various SEDI quintiles and with the majority of specific causes of avoidable mortality. The distribution profile of AM indicators among SEDI communal quintiles reflects the same tendency, along with most of the mortality from specific avoidable causes. The use of three reference values (the mean, the quintile with the greatest SEDI, and the optimal empirical reference value) makes it possible to measure gaps that could be avoided. The ratio of the lowest SEDI quintile to the empirical optimal reference value was 2.1 for AM, 2.0 for PYLL, 1.7 for infant mortality, and 1.5 for HCAMR. CONCLUSIONS: These results, which are consistent with those found in previous published sources, estimate the magnitude and pattern of variations among communes. The results also provide information, based on data for 1992, with which to start monitoring health inequalities among small geographic areas, which were communes in this particular case. Although interventions for promoting equity tend to focus exclusively on communes having lower socioeconomic development and higher rates of avoidable mortality, reducing the latter implies a two-pronged approach: prioritizing interventions targeting underprivileged communes so as to foster equity, while attempting to cover the majority of communes in an effort to prevent avoidable mortality.

Adolescent↗
PubMedDate not supplied

An experimental study of determinants of group judgments in clinical guideline development.

BACKGROUND: Clinical guidelines for improving the quality of care are a familiar part of clinical practice. Formal consensus methods such as the nominal group technique are often used as part of guideline development, but little is known about factors that affect the statements produced by nominal groups, and on their consistency with the research evidence. METHODS: Cognitive behavioural therapy, behavioural therapy, brief psychodynamic interpersonal therapy, and antidepressants for irritable bowel syndrome, chronic fatigue syndrome, and chronic back pain were selected for study. 16 nominal groups in a factorial design allowed comparison of GP-only with mixed groups of GPs and specialists, provision of a literature review with no provision, and ratings made in the context of realistic or ideal levels of health-care resources. Participants rated appropriateness independently, and again after a facilitated meeting. Audiotapes of four group discussions were analysed. FINDINGS: There was agreement with the research evidence for 51% of 192 scenarios. Agreement was more likely if the group was GP-only, if a literature review was provided, or if the evidence was in accordance with clinicians' beliefs. Assumptions about the level of resources available had no impact. Clinical and social cues had mixed effects, irrespective of the research evidence. Qualitative analysis showed the modifying effect of clinical experience and beliefs about research evidence. INTERPRETATION: Guidelines cannot be based on data alone; judgment is unavoidable. The nominal group technique is a method of eliciting and aggregating judgments in a transparent and structured way. It can provide important information on levels of agreement between experts. However, conclusions can be at odds with the published literature. If they are, reasons need to be explicit.

Back Pain↗