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Biomedical subjects

E I Williams

Publications and source records attributed to E I Williams.

At least 19 recordsLinked to original sources
PubMed1992

Health checks on patients 75 years and over in Nottinghamshire after the new GP contract.

OBJECTIVE: To investigate annual health checks for patients of 75 years and over required by the 1990 contract for general practitioners. DESIGN: Visits to practices to collect information on how assessments were organised and carried out; completion of questionnaires for every patient who had been assessed in a sample month, using information provided by the practice records. SETTING: 20 general practices in one family health services authority. SUBJECTS: Patients of 75 years and over in 20 general practices. RESULTS: Three practices (15%) had not performed checks. Thirteen practices sent a letter to invite patients to undergo a check. Of these practices, seven followed up non-responders. Two practices visited patients' homes unannounced, and two did checks on an opportunistic basis only. Sixteen practices used a checklist. Sixteen practices involved their practice nurses; at eight of these, doctors also performed checks; in six practices the nurses undertaking the checks had no training in assessing old people. Ten practices assessed more than 75% of their old people in the first year of the new contract. Practices that did not follow up patients who had not responded to the invitation for assessment completed significantly fewer checks. During the sample month, 331 patients were assessed in the 17 practices. 204 new problems were discovered in 143 patients. Significantly more problems per patient were found in inner city areas. CONCLUSIONS: The way health checks were performed varied greatly, both in their organisation and the practices' attitudes. Many old people did not respond to letters asking if they wanted an assessment but very few refused one if followed up. Forty three per cent of those assessed had some unmet need. The number of new problems found per patient may reduce over the next few years if the assessments are successful. The need for annual assessment should be kept under review and adequate resources made available for the needs uncovered. Improved training for practice nurses in assessment is needed. Effectiveness of the checks must be monitored. If most unmet need falls in particular high risk groups it would seem sensible to modify the annual check to target these groups.

Aged↗
PubMed1992

The care of people over 75 years old after discharge from hospital: an evaluation of timetabled visiting by Health Visitor Assistants.

The objective of this study was to evaluate a programme of timetabled visiting by Health Visitor Assistants (HVAs) to patients over 75 years old who were recently discharged from hospital. An outcome evaluation examined whether patients benefited in measured health status and use of services over the year of the programme. A randomly selected group of patients (the intervention group) who were allocated to the programme of visiting were compared with an equal-sized randomly selected group of patients (the control group) who had no timetabled visiting. A process evaluation examined the actions taken by HVAs during their visits and related the actions taken to patients' measured health status and other characteristics. No overall benefit from the programme of visiting was found in the outcome evaluation. There was wide variation in the numbers of actions recorded for different patients. Numbers of HVAs' actions were related to patient's health status and sex, with more actions being initiated for those in poorer health and women. Neither age nor whether the patient lived alone were found to be related to numbers of HVAs' actions. It was concluded that the lack of demonstrated overall benefit and the wide variation in actions taken on patients' behalf suggest that this type of service cannot be recommended for all discharged patients over 75 years. Poor health at the time of discharge is recommended as a first choice of measure for need of support. Exchange of information between general practice and hospital about previous dependency may aid the identification of patients who need post-discharge support.

Activities of Daily Living↗
PubMed1992

Characteristics of patients aged 75 years and over who are discharged from hospital without district nursing support.

To investigate the state of health and needs of over-75-year-olds discharged from hospital and not referred to the District Nurse Service, patients in this age group who were discharged from hospital, who returned to their own or a relative's home and were not referred to the District Nurse Service were interviewed by Health Visitors during their normal post-discharge visit. Assessment was by a questionnaire on details of discharge, statutory, voluntary and informal support, physical status, disability level, ability to self-care and mental status. It was found that there was wide variation in timing of Health Visitors' post-discharge visits, and most patients had had some contact with their GP before this visit. Almost half the patients were discharged from General Surgery or surgical specialties. Most patients were fairly healthy but a minority had severe disabilities. Physical status, disability level and ability to self-care were related to age and sex of the patient, with older patients and women having poorer health status. Women had poorer mental status than men. It is concluded that the wide variety in health status and needs of this group of patients suggest that they should be taken into account in the planning of new discharge procedures. Closer links between the hospital, community teams and general practice are suggested.

Activities of Daily Living↗
PubMed1992

Residents of private nursing homes and their care.

A study was undertaken to examine the characteristics of residents in private nursing homes, to measure residents' dependency levels, to determine the adequacy of procedures for admitting new residents and to explore general practitioners' work with residents. Details were obtained of 61 nursing homes registered by Nottingham district health authority and of a selection of residents. Information about residents provided by the nurses in charge included aspects of self care, orientation and social integration, these items contributing to a dependency score for each resident. General practitioners completed postal questionnaires. Information was sought on the numbers of residents on the general practitioners' lists, visiting patterns, and opinions on their work with residents. It was found that almost half of the reports accompanying residents on admission were considered inadequate by the nurses in charge. The 357 residents varied widely in dependency level, need for nursing care and medication; 31% had low dependency scores. Most of the residents (57%), had been admitted from hospital, 26% from their own home and 15% from other nursing or residential homes. Higher overall dependency levels, problems with mobility and continence and need for care of wounds, catheters or colostomies were more frequent in residents admitted from hospital or nursing or residential homes than in those admitted from their own home. The 70 responding general practitioners varied widely in the numbers of residents on their lists and in their visiting patterns. The 16 general practitioners providing medical care for entire nursing homes were significantly more likely than the other general practitioners to visit routinely.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Use of nursing and social services by elderly patients discharged from hospital.

As part of a study to determine reasons for early unplanned readmission of elderly patients to hospital, the provision of nursing and social services before and after admission was assessed for two groups of patients aged 65 years and over. A random sample of 133 patients who had been readmitted in an emergency and 133 matched controls who had not been readmitted were interviewed. Prior to the first admission the readmitted patients had received more services than the control patients. A substantial number of patients had had some services organized for them before leaving hospital. There was a net increase in the provision of district nursing services for both groups. The readmitted group had significantly more nursing and social services both before and after discharge than the non-readmitted group. The level of district nursing, home help and social work all increased significantly with age. Problems were experienced with services after discharge from hospital. These included: no arrangements, delay in starting services and inadequate services to meet the patient's needs. Guidelines for the provision of nursing and social services after discharge of patients from hospital are suggested.

Aged↗
PubMed1991

Survey of carers of elderly patients discharged from hospital.

As part of a study to determine reasons for early unplanned readmission of elderly patients to hospital, the problems experienced by the carers of two groups of patients aged 65 years and over were analysed. Carers of 100 patients who had been readmitted in an emergency and 93 control patients were interviewed. The majority of carers were aged 60 year or over and two thirds were women. Forty one per cent of the carers were the patient's spouse. Forty per cent of the carers did not live with the patient. Many of the carers had been attending to the personal and domestic needs of their dependents for a considerable time. Carers complained about the effect the task had on their own health and the high levels of frustration experienced. Carer problems were important principal and contributory reasons for readmission. Carers of readmitted patients experienced more problems, frustrations and concerns than the carers of control patients. It is suggested that communication between professionals and carers should be improved, and, in particular, that the needs of carers should be assessed before discharge of patients from hospital.

Adult↗
PubMed1990

General practitioner response to elderly patients discharged from hospital.

OBJECTIVE: To determine the effect of discharge information given to general practitioners on their management of newly discharged elderly patients. DESIGN: A random sample of 133 elderly patients who had unplanned readmission to a district general hospital within 28 days of discharge was compared with a matched control sample of patients who were not readmitted. Information was gathered from the hospital, the patients, the carers, and the general practitioners about the information that the hospital had sent the general practitioner and the general practitioners' response to this information. SETTING: All specialties in a district general hospital. PATIENTS: 266 Patients aged over 65 representative in the main demographic indices of the population of elderly patients admitted to hospital. RESULTS: Ten weeks after discharge the doctors had received notice of discharge about 169 of the patients, but fewer than half the discharge notices were received within the first week. General practitioners were dissatisfied with the information in 60 cases. A general practitioner visited 174 of the patients after their discharge from hospital and three quarters of the visits took place within two weeks of the discharge. These visits were more likely to have been initiated by patients or families than by the doctor, and this was not influenced by the doctor receiving notice of the patient's discharge. Older patients and those who had carers were the most likely to be visited. Nearly half of the carers were dissatisfied with some aspect of general practitioner care, problems with home visiting being the commonest source of complaint. CONCLUSIONS: Hospital communications to general practitioners about the discharge of elderly patients still cause concern, particularly in the time they take to arrive. Written instruction to vulnerable elderly patients asking them to inform their general practitioner of the discharge might be helpful. Carers complained of lack of support, and it is clearly important for someone (either the general practitioner or another health worker) to visit elderly people shortly after their discharge.

Aged↗
PubMed1990

Dyspepsia in England and Scotland.

A validated postal questionnaire has been used to establish the prevalence of dyspeptic symptoms in five geographical locations from the south coast of England to the north of Scotland. The six month period prevalence of dyspepsia in the 7428 respondents to the questionnaire is 41% and equal between the sexes, with similar prevalence rates in the centres studied. There is considerable overlap between upper abdominal symptoms and symptoms of heartburn; 56% of patients with dyspepsia experience both groups of symptoms. Symptom frequency falls progressively with age in men and women, but the proportion of people seeking medical advice for dyspepsia rises with age. One quarter of the dyspeptic patients studied have consulted a general practitioner about their symptoms. This study suggests that the prevalence of dyspepsia in the community has changed little over the last 30 years, despite evidence that the frequency of peptic ulcer disease is falling. Symptom prevalence is unrelated to social class, but this factor is associated with consultation behaviour, the consultation rate rising from 17% in social class 1 to 29% in social class 4. The use of investigations--barium meal and endoscopy--is similarly related to social class; the lowest rate for ulcer diagnosis (4.7%) is found in social class 1 and the highest (17.1%) in social class 5.

Adult↗
PubMed1988

Factors affecting early unplanned readmission of elderly patients to hospital.

A random sample of 133 elderly patients who had an unplanned readmission to a district general hospital within 28 days of discharge from hospital was studied and compared with a matched control sample of patients who were not readmitted. The total group was drawn from all specialties in the hospital, and by interviewing the patients, their carers, the ward sisters, and the patients' general practitioners the factors causing early unplanned readmission for each patient were identified. Seven possible principal reasons were found: relapse of original condition, development of a new problem, carer problems, complications of the initial illness, need for terminal care, problems with medication, and problems with services. There were also contributory reasons, and it was usual for several of these to be present in each case. The unplanned readmission rate was 6%; the planned readmission rate was 3%. It was thought that unplanned readmission was avoidable for 78 (59%) patients. Patients in the study group and in the control group showed significant differences in certain characteristics--such as low income, previous hospital admission, already having nursing care, and admission by general practitioners--and this might help to identify patients who are likely to be readmitted in an emergency.

Aged↗
PubMed1987

Health care units: an extended alternative to the Cumberlege proposals.

The proposals of the Cumberlege report are reviewed as they relate to general practitioners and the effectiveness of the primary health care team. An alternative proposal is described which uses combined general practitioner lists rather than a neighbourhood boundary to define the population served by a ;health care unit'. This would be the basis for both general practitioner and nursing care, and would allow effective multidisciplinary teamwork, as well as encouraging cooperation between general practices and the development of community general practice.

Catchment Area, Health↗
PubMed1986

Patterns of care for the elderly in general practice.

Little is known about the care provided for the elderly by general practitioners. This study is based on data from 89 030 consultations with patients of all ages of which 17 771 were with patients over 65 years of age. It was found that general practitioners carry out more follow-up work with their elderly patients than with their younger patients and they make more home visits and referrals to nursing and social services. However, they do less investigative work with elderly patients and the level of referral to consultants is the same for patients of all ages. Considerable variation was found between doctors in the pattern of care provided for older patients. The proportion of elderly patients on the list of a general practitioner had little effect on his overall workload. The implications of these findings for health service research and planning are discussed.

Adolescent↗
PubMed1986

A model to describe social performance levels in elderly people.

In elderly patients illness clearly affects both their social activity and their ability to care for themselves. It is important in general practice to recognize this effect when managing old people with acute and chronic illness. A model is described which aims to facilitate estimations of social performance at various levels. By carrying out this estimation the type of ;social' help needed can be better assessed. The model's usefulness in anticipatory care is also described.

Activities of Daily Living↗