Biomedical subjects

D Boot

Publications and source records attributed to D Boot.

14 recordsLinked to original sources

PubMed2000

Age and proximity to death as predictors of GP care costs: results from a study of nursing home patients.

This paper reports the results of a study of GP costs associated with a group of nursing home patients who died at various stages during a 12-month period. The relationship between costs per month of care, patient age and proximity to death, where sex and diagnosis are controlled for are reported. A comparison of care costs for patients in their last year of life and those who survived the course of the study is also made. The study found that those in their last year of life were significantly more expensive to care for than those who survived the duration of the study, but that there was no statistically significant difference in age. In multivariate regression analyses, it was also found that among those who died during the study care costs were unrelated to age, but significantly related to proximity to death. The study supports the contention of others (Zweifel P, Felder S, Meiers M. Ageing of population and health care expenditure: a red herring? Health Econ 1999; 8: 485-496) that health care costs are more directly related to proximity to death than age.

Age Factors↗

PubMed2000

The impact of nursing home patients on general practitioners' workload.

BACKGROUND: Although the number of people in nursing homes has risen substantially in recent years, the shift of responsibility into general practice has rarely been accompanied by extra resources. These patients may be associated with a higher general practitioner (GP) workload than others of similar age and sex. AIM: To assess the GP workload associated with nursing home residents and its associated costs. METHOD: All nursing home residents aged over 65 years and registered with nine Nottinghamshire practices during one year were matched with patients living in the community for general practice, age, and sex. Data were collected retrospectively for both groups on key workload measures. Costs for the workload measures were calculated using published estimates. RESULTS: Data were collected for 270 pairs of patients. Nursing home patients had more face-to-face contacts in normal surgery hours, telephone calls, and out-of-hours visits. The mean workload cost per month of a nursing home patient (assuming that one patient was seen per visit) was estimated to be 18.21 Pounds (10.49 Pounds higher than the cost of controls). A sensitivity analysis demonstrated that potential savings in visiting costs associated with increasing the numbers of patients seen per visit were 27% for one extra patient seen per visit and 44% for four extra patients. CONCLUSION: Nursing home residents were associated with higher workload for GPs than other patients of the same age and sex living in the community. Our costings provide a basis for negotiating suitable reimbursement of GPs for their additional work.

Aged↗

PubMed2000

Variations in GP nursing home patient workload: results of a multivariate analysis.

The number of old people living in UK nursing homes has increased substantially over the past 15 y. There is evidence that such patients generate larger workloads for primary carers than do those of similar age and sex living in their own homes. Clearly, any extra workload involved in providing primary care services to nursing home patients, needs to be reflected in the resources afforded general practitioners (GPs) who are tasked with its provision. By the same token variations in workloads between patients need to be examined and explained for any insights these might provide on funding issues. To examine and explain variations in GP workload associated with nursing home patients and determine the implications of these for GP funding, a 12 month case control study of all nursing home residents over 65 y old registered with nine general practices was undertaken. A multivariate regression analysis was used to examine variations in GP workload associated with 270 nursing home patients. Multivariate regression models explaining the variation in workload cost per month in terms of the GP practice delivering care and patients age and sex had little explanatory power (R(2)=0.07). A fuller method including the patient's Barthel score and initial diagnosis as additional explanatory variables added little to the explanatory power of the model (R(2)=0.12). The ability of the multivariate models used here to explain the variation in GP workload was poor. GPs may require an allowance to compensate for differences in workload associated with nursing home patients but adjusting these payments for differences in age, sex, initial diagnosis or the other variables included in this analysis would not appear to be supported.

Aged↗

PubMed1999

Anxiety and depression disorders 5 years after severe injuries: a prospective follow-up study.

Individuals with severe injuries were investigated 5 years after the traumatic events, and predictors of anxiety and depression disorders were identified. Trauma victims were selected who had an Injury Severity Score of > or = 16 and were brought to all hospitals in the Mersey region and North Wales over 1 year. The 212 patients aged > or = 15 years who left the hospital alive and lived within an accessible distance of the study hospital in Warrington were contacted 5 years later and 158 (74.5%) received follow-up assessment. Thirty-eight subjects (36.9%) reported "definite" anxiety and/or depression disorders and, of these, only 21.1% reported taking psychotropic medications. Factors associated with anxiety and/or depression disorders at follow-up were: sequelae of head injury (i.e., cognitive problems, posttraumatic seizures, facial pain): writing impairment: disability due to thorax problems; and a new trauma during follow-up. Initial severity or types of injuries and overall residual disability rated by the investigator were not strong predictors of anxiety and/or depression disorders at follow-up.

Adolescent↗

PubMed1999

The impact of nursing home patients on prescribing costs in general practice.

OBJECTIVES: To compare the costs of prescribing for older people in nursing homes with older people living at home and to compare patterns of prescribing between these two groups. DESIGN: Retrospective case-control study. SETTING: Nine general practices in Nottinghamshire. SUBJECTS: Two hundred and seventy patients aged 65 years and over living in nursing homes matched for age, sex and general practice, with 270 patients living in their own homes. MAIN OUTCOME MEASURES: A comparison of the costs of prescriptions, the number of items on prescription and the types of drugs prescribed between the cases and controls. RESULTS: The mean cost of prescriptions per patient month was almost three times higher for nursing home patients than controls (45.27 pounds compared to 16.46 pounds). The mean number of items prescribed per patient month was also higher in nursing home patients (5.60 compared to 2.55). Total costs of prescriptions for nursing home patients were higher than for controls (P < 0.0001), as were total numbers of prescription items (P < 0.001). There were differences in the types of medication prescribed between the two groups, including considerably higher costs for central nervous system drugs, ulcer healing drugs, laxatives and enteral nutrition in nursing home residents. CONCLUSIONS: When calculating general practice prescribing budgets, nursing home patients should have a greater weighting than other patients of similar age and sex.

Aged↗

PubMed1999

Explaining variations in prescribing costs: results from a comparison of nursing home patients with matched pairs living in the community.

OBJECTIVES: To examine and explain variations in prescribing costs associated with nursing home patients and patients matched by age and sex living in the community. DESIGN: A 12-month case control study. SUBJECTS: All nursing home residents over 65-years-old registered with nine general practices and patients matched with them for age and sex living in the community. METHOD: Multivariate regression analysis of variations in monthly GP prescribing costs. RESULTS: Multivariate regression models explaining cost variations in terms of the GP practice delivering care and patients' age and sex had little explanatory power (R(2)=0.07 for nursing home patients, R(2)=0.03 for matched pairs). A fuller model for nursing home patients only, incorporating the patient's Barthel score and initial diagnosis as additional explanatory variables, added little to the explanatory power of the model (R(2)=0.16). CONCLUSION: The ability of the multivariate models used here to explain variations in prescribing costs among a group of elderly patients is poor. Adjusting weighted capitation formulae with respect to older patients to take account of such information or referring to it in negotiations on prescribing budgets would not appear to be warranted.

Age Factors↗

PubMed1999

What problems do patients present with outside normal general practice surgery hours? A prospective study of the use of general practice and accident and emergency services.

BACKGROUND: This study was designed to address some current issues concerning the use of general practice and accident and emergency (A & E) services outside normal surgery hours. METHOD: Six general practices in Nottingham (with a combined population of 46,698 patients) were recruited to take part in the study. Over a six month period, data were collected on patient contacts with general practice services and the local A & E department outside normal surgery hours. RESULTS: General practice services dealt with 63 per cent of first contacts over the course of the study. There were 3181 (136 per 1000 patients per year) contacts with general practitioners and deputizing service doctors (of which 1009 (31.7 per cent) were dealt with by telephone alone) and 1876 (80 per 1000 patients per year) attendances at the A & E department. There were marked differences in the distribution of problems that patients presented to the two types of service. The proportion of presentations dealt with by telephone alone by general practice services varied with the type of presentation. However, the use of the telephone was not particularly high, even for problems such as a sore throat. CONCLUSIONS: Given the differences in presentations to both general practice and A & E services there may be limited scope for altering patients' consulting patterns without making significant changes to service provision. However, there may be scope for increasing the proportion of general practice contacts dealt with by telephone alone.

Accidents↗

PubMed1998

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey.

OBJECTIVES: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. DESIGN: Six month longitudinal study. SETTING: Six general practices and the sole accident and emergency department in Nottingham. SUBJECTS: 4745 out of hours contacts generated by 45,182 patients from 23 electoral wards registered with six practices. MAIN OUTCOME MEASURES: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards. RESULTS: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from -23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P = 0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis. CONCLUSIONS: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other.

Emergency Service, Hospital↗

PubMed1997

Problems found in the over-75s by the annual health check.

BACKGROUND: Research into the health of elderly people has found problems unknown to their general practitioners. It was anticipated that annual checks, as required by the 1990 general practitioner contract, would help to detect these problems, yet the value of these checks has been questioned. AIM: To investigate the problems found by general practice contractual annual checks of the over-75s and the consequent actions taken; to identify patient, demographic or practice characteristics associated with the discovery of problems. METHOD: In 40 practices, information was collected on patients over 75 years of age receiving a health check during a 3-month period. Practices used their normal methods of recruitment and assessment. Practice staff were interviewed to find how assessments were organized. RESULTS: Practices saw a mean of 12% of their over-75s during the study; 44% were found to have at least one problem. Action was taken to help resolve problems in 82% of patients with a problem. The most prevalent problems related to physical condition, and fewer functional problems than expected were found. There were large differences between practices in the proportions of elderly patients seen for a check and the proportion found to have problems; these were not attributable to practice size or demography. Multivariate analysis showed that practice or patient characteristics were poor predictors of finding problems. CONCLUSION: The argument in favour of conducting annual checks is supported by the finding that nearly half the patients assessed were found to have problems for which some action was taken. Some practices could increase their rate of uptake by modifying the organization of invitations for checks. More problems may be found by adopting a more functionally based assessment.

Aged↗

PubMed1996

The epidemiology of pelvic fractures in the Mersey Region.

The Mersey Region Trauma Survey was performed over 12 months in 1989 and 1990 to study the epidemiology of trauma in a population of 3,200,000. All deaths from injuries, and all survivors with an injury severity score of 15 or over were included, giving a total of 1088 cases. This paper, primarily epidemiological, considers those victims with a pelvic fracture (153 patients), and especially those who reached hospital alive (111 patients). The epidemiology, hospital care and mortality are considered, but the specific management of individual fractures is not.

Abdominal Injuries↗

PubMed1994

Evaluation of the short-term impact of counseling in general practice.

This paper describes the findings of a randomised controlled trial of the short-term impact of counseling in the general practice setting. Compared with patients who received usual advice from their general practitioner for acute problems such as relationship difficulties, anxiety and depression, those who received counseling from qualified counselors working within the primary health care context showed greater improvement in psychological health as measured by the General Health Questionnaire. Significantly fewer of those counselled were prescribed anti-depressant drugs by the general practitioners in the study, or were referred to psychiatrists or clinical psychologists for care. In addition those patients who attended sessions with the practice counselor were more likely to report that they were satisfied with their treatment and more expressed feelings of well-being.

Adult↗

PubMed1991

Ethnic factors in voluntary and compulsory admissions.

Socio-demographic and clinical aspects of compulsory and informal admissions to general adult psychiatry wards over a two-year period are compared. In addition, Afro-Caribbean patients are compared with white UK-born patients. Relative rates of admission are examined. The study confirms other reports of greater than expected compulsory admissions of Afro-Caribbean patients and pays particular attention to the circumstances preceding compulsory entry to hospital and the persons and agencies involved in that process.

Adolescent↗

PubMed1989

Severe mental disorder in Afro-Caribbean patients: some social, demographic and service factors.

Forty-two consecutively identified Afro-Caribbean patients with a first episode of psychosis were compared with a similar group of non-Caribbean patients. A number of differences emerged, although the same proportion of patients in each group had symptoms for 6 months or more prior to psychiatric contact. Afro-Caribbean patients showed greater delay in seeking help, more 'disturbance' later in the course of their illness and were more likely to be admitted compulsorily. The social geography of the two groups suggests that the high rates of schizophrenia and related psychoses that we previously reported cannot be explained simply by differences in area of residence at the time of presentation.

Adult↗

PubMed1988

A prospective study of severe mental disorder in Afro-Caribbean patients.

Several previous studies have reported increased rates of schizophrenia among Afro-Caribbean immigrants, although doubt has been cast upon the value of case-note diagnoses and retrospective case-finding. A prospective study was therefore undertaken, including all patients of Afro-Caribbean ethnic origin with a first onset psychosis presenting to the psychiatric services from a defined catchment area. Utilizing several diagnostic classifications, rates for schizophrenia were found to be substantially increased in the Afro-Caribbean community, and especially in the 'second generation' British born. Mode of onset and symptom profiles of psychoses suggest that atypical syndromes, and by implication 'misdiagnoses', do not account for reported higher rates of schizophrenic illness in these patients.

Adolescent↗