Biomedical subjects

Elizabeth Goyder

Publications and source records attributed to Elizabeth Goyder.

6 recordsLinked to original sources

PubMed2006

Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care?

BACKGROUND: There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. METHODS: Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. RESULTS: The proportion of sampled respondents whose first language was not English and the ratio of general practitioners to population explained 61% of variation. Deprivation and mental health status were not significant predictors of prescribing in these relatively deprived communities. CONCLUSION: These findings suggest that mental health prescribing, within deprived areas, as well as reflecting cultural and social differences in prescribing, may also be a proxy measure of access to care.

Journal Article↗

PubMed2006

Patient and professional perspectives on prescribed therapeutic footwear for people with diabetes: a vignette study.

OBJECTIVE: This article draws on a qualitative study to identify and discuss patient and health professional views of the use of therapeutic footwear for people with diabetes-related foot complications. METHODS: Semi-structured interviews were conducted with 15 patients and 15 health professionals using a 'vignette' technique. The interviews were audio-taped, and framework analysis was used to identify main themes and categories. RESULTS: The prescription of therapeutic footwear was an important issue for patients, and health professionals were aware of this. The main issues were the differing perspectives between patients and professionals in terms of the expectations and reality of preventive behaviour, and difficulties in fitting shoes when feet are constantly changing shape. CONCLUSIONS: Patients often have difficulty changing their shoe-wearing behaviour in line with guidelines, particularly within the limits of available therapeutic shoes. The choice of available shoes may not meet the varied and specific needs of patients. Patient perspectives therefore need to be taken into account in shoe provision. PRACTICE IMPLICATIONS: The concept of concordance would appear to be useful in allowing patient needs to be identified before designing and prescribing therapeutic shoes. More choice in styles, and involving patients in footwear design and selection, might encourage the use of appropriate footwear.

Activities of Daily Living↗

PubMed2005

The DiGEM trial protocol--a randomised controlled trial to determine the effect on glycaemic control of different strategies of blood glucose self-monitoring in people with type 2 diabetes [ISRCTN47464659].

BACKGROUND: We do not yet know how to use blood glucose self-monitoring (BGSM) most effectively in the self-management of type 2 diabetes treated with oral medication. Training in monitoring may be most effective in improving glycaemic control and well being when results are linked to behavioural change. METHODS/DESIGN: DiGEM is a three arm randomised parallel group trial set in UK general practices. A total of 450 patients with type 2 diabetes managed with lifestyle or oral glucose lowering medication are included. The trial compares effectiveness of three strategies for monitoring glycaemic control over 12 months (1) a control group with three monthly HbA1c measurements; interpreted with nurse-practitioner; (2) A self-testing of blood glucose group; interpreted with nurse- practitioner to inform adjustment of medication in addition to 1; (3) A self-monitoring of blood glucose group with personal use of results to interpret results in relation to lifestyle changes in addition to 1 and 2. The trial has an 80% power at a 5% level of significance to detect a difference in change in the primary outcome, HbA1c of 0.5% between groups, allowing for an attrition rate of 10%. Secondary outcome measures include health service costs, well-being, and the intervention effect in sub-groups defined by duration of diabetes, current management, health status at baseline and co-morbidity. A mediation analysis will explore the extent to which changes in beliefs about self-management of diabetes between experimental groups leads to changes in outcomes in accordance with the Common Sense Model of illness. The study is open and has recruited more than half the target sample. The trial is expected to report in 2007. DISCUSSION: The DiGEM intervention and trial design address weaknesses of previous research by use of a sample size with power to detect a clinically significant change in HbA1c, recruitment from a well-characterised primary care population, definition of feasible monitoring and behaviour change strategies based on psychological theory and evidence, and measures along the hypothesised causal path from cognitions to behaviours and disease and well being related outcomes. The trial will provide evidence to support, focus or discourage use of specific BGSM strategies.

Adult↗

PubMed2005

Meeting the educational needs of people at risk of diabetes-related amputation: a vignette study with patients and professionals.

OBJECTIVE: To investigate how patients and professionals view the role of advice in diabetes foot care, in order to inform educational practice. DESIGN: A qualitative study based upon one-to-one interviews using a vignette technique with patients and professionals. SETTING AND PARTICIPANTS: Interviews with 15 patients with diabetes-related foot complications attending diabetes foot clinics, and 15 health professionals across two hospital sites and two primary care trusts. RESULTS: There were similarities between issues raised by patients and professionals, with differences in emphasis. An important factor was patient understanding and acceptance of the implications of diabetes from diagnosis. Many patients reported a lack of early understanding that may reflect inadequate provision or acceptance of advice. Development of positive relationships with health professionals was important for patients and encouraged shared understanding. Use of the vignette technique highlighted the gap between patient knowledge and action, with patients and professionals emphasizing their own responsibilities in relation to reduction of risk through education and action. Responses suggest that early positive interactions with appropriately trained professionals are needed to help patients assimilate advice into everyday routines. CONCLUSIONS: For effective preventive care, patients need to understand how diabetes impacts on their health. Foot care education should begin early, be patient-centred and delivered with empathy by professionals whom the patients trust. The findings reflect patient and professional expectations in educational practice, and therefore have relevance for other chronic conditions for which much education and advice is related to self-care.

Adult↗

PubMed2003

Active life expectancy in people with and without diabetes.

BACKGROUND: The aim of the study was to investigate the feasibility of monitoring older people's health by measuring active life expectancy among older people with and without diabetes using routinely collected primary care data. METHODS: The study comprised the first five rounds of a routine health assessment of those aged 75 years and over belonging to a large Midlands general practice (list size 32,500). A nurse carried out the health assessments in the participant's home. Being active was defined as the ability to perform (without difficulty, help or use of aids) at least six of seven activities of daily living (ADLs). Mortality data were collected through the practice register together with regular linkage to information from the Office for National Statistics. Period health expectancies were calculated for those known or found to be diabetic through the health assessments and for non-diabetic individuals. RESULTS: Calculation of active life expectancies (ALE) was based on 2,474 persons (212 with and 2,262 without diabetes). At all ages, people with diabetes had lower life expectancy and spent fewer years active. The proportion of remaining life spent active was, however, similar for both groups at younger ages, but by age 85 years people with diabetes spent only 32 per cent of remaining life active compared with 42 per cent for those without diabetes. CONCLUSION: Annual health assessments of the over-75s in primary care together with linkage to mortality data provide a feasible method of monitoring older people's health, particularly for subgroups at greater risk of disability. At Strategic Health Authority or Primary Care Trust level these methods can monitor health needs, highlight health inequalities and evaluate intervention strategies.

Activities of Daily Living↗

PubMed2003

Explaining variations in reported diabetes prevalence in general practice: how much variation is explained by differences between practice populations?

There are large variations in reported diabetes prevalence within United Kingdom (UK) populations. Linear regression was used to investigate whether population characteristics could explain the variation in prevalence between 19 practices with relatively complete diagnostic recording. Population obesity and South Asian ethnicity largely explained observed variation in prevalence (adjusted R2 = 0.80). When adjusted for obesity and ethnicity, the deprivation score was no longer a predictor of diabetes prevalence. If true variation in prevalence between practices is largely predicted by population ethnicity and obesity, these population characteristics could be used to predict expected prevalence and to assess the completeness of practice registers.

Aged↗