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Biomedical subjects

G J Elwyn

Publications and source records attributed to G J Elwyn.

12 recordsLinked to original sources
PubMed1999

Referral for 'prostatism': developing a 'performance indicator' for the threshold between primary and secondary care?

OBJECTIVE: We aimed to define a performance indicator at the gateway between primary and secondary care. METHOD: We carried out an analysis of referral letters sent to an urological department within the catchment area of a teaching hospital in Cardiff, Wales. The subjects were 221 sequential referral letters from 221 GPs. The main outcome measures were the information content of referral letters analysed. Letters were stratified into referral threshold groups by the presence of history, examination, routine investigations and specialized investigations. RESULTS: Three distinct categories of referral practice were identified: referrals which contained history alone; those providing history examination and a selection of routine investigations; and those providing history, examination data and the results of routine and specialized investigations. The study demonstrated that more than a third of GPs do not report the results of digital rectal examination in their referrals and only 4% record urinary flow rates and post-micturition residual urine volume. CONCLUSIONS: The majority (60%) of generalist referrals to an urology department for prostatism provide enough information for specialists to be able to prioritize appointments, but more than a third (36%) of the referrals contain inadequate information. The method has the potential of being developed into a gateway performance indicator in clinical practice.

Family Practice↗
PubMed1998

The implementation of prompted retinal screening for diabetic eye disease by accredited optometrists in an inner-city district of North London: a quality of care study.

Diabetic retinopathy remains the most common cause of blindness in people of working age but the provision of high quality eye screening for diabetic patients is still erratic in many health districts in the UK. National consensus guidelines recommend comprehensive population coverage, high sensitivity (>80%), high specificity (>95%), agreed clinical criteria, referral procedures and centralized data collection to facilitate audit. This study looks at the effectiveness of implementing a prompted recall programme for retinal screening in an inner-city district of North London. The scheme uses trained, accredited optometrists to screen patients with diabetes who are looked after in the community by their general practitioner. During the first 17 months of the scheme, 63 optometrists attended training and gained accreditation. Of the 666 patients recruited, 645 were scheduled for screening and 536 (83%) attended. Fourteen per cent of patients screened were found to have background retinopathy and 2.3% sight-threatening eye disease. In two audits, carried out 15 months apart in a random sample of GP practices, the incidence of recorded dilated fundoscopy increased from 48% at baseline to 56%, an increase of 8% (95% CIs 2%-14%). For referable eye disease, the sensitivity of this screening technique was 100%, the specificity 94% (95% CIs 90%-98%), the positive predictive value 79% (95% CIs 72%-86%) and the negative predictive value 100%. The administrative cost per case screened was Pound Sterling 12.60 (excluding clinical costs and any additional optometry payment).

Diabetic Retinopathy↗
PubMed1998

Planning and producing an educational videotape on the cervical screening programme in Wales.

Planning and producing an instructional videotape for health care workers require attention to educational principles but also depend on project management skills. The paper describes an approach to the planning and production of a programme on the cervical screening service in Wales that used focus groups to obtain information about needs assessment and developmental testing. Learning objectives need to be married with content accuracy and policy consensus, often difficult to achieve for health care areas such as cervical screening. For these reasons, effective and close liaison is required between sponsor, content experts, scriptwriter, producer and director.

Education, Continuing↗
PubMed1997

Measuring general practice-based primary care: generic outcomes. Welsh Primary Care Outcomes Group.

Increasing attention is being paid to the measurement of outcomes in primary care. However, many of the methods proposed are measures based on readily collectable data or standardized population measures of health status. These may interest population scientists but are unlikely to satisfy most primary-care clinicians. The reason for this dissonance is that the population measures do not reflect the complex and personal nature of primary care. Quality measures are needed that have validity to clinicians and patients. An alternative classification is proposed which is based more formally on the functions of primary care. This would appear to provide a framework which is more likely to be valued by those who provide primary care. The need for further research and testing of some outcome measures is identified.

Clinical Competence↗
PubMed1996

Waiting list management in general practice: a review of orthopaedic patients.

OBJECTIVE: To review all patients on a current general practice orthopaedic waiting list for outpatient appointments with regard to accuracy of the list, clinical priority, and need for further radiological investigation before hospital attendance. DESIGN: Record review by one general practitioner and a radiologist, and discussion with patients of management alternatives. SETTING: Six partner city centre urban fund-holding general practice, list size 8651 (29% low deprivation payment status). SUBJECTS: 116 adults on an orthopaedic waiting list. MAIN OUTCOME MEASURES: List accuracy (patient details and status on waiting list); clinical priority (severity of condition); further investigations (results of tests after radiological review). RESULTS: 32 patients (28%) were removed from the waiting list because of inaccuracies. 14 patients were considered to be high priority and referred to other hospitals by utilising waiting list initiative funds. Of these patients, five agreed to referral to another hospital (treatment completed on average within three months of rereferral), six did not wish to be rereferred, and two did not attend to discuss the offer and remained on the original waiting list. One prioritised patient had further radiological investigations, was reassured, and was taken off the waiting list. 10 patients had further investigations. These resulted in six patients being referred to other hospitals, three being taken off the waiting list, and one seeking private care. CONCLUSIONS: Systematic review of patients on an orthopaedic waiting list of one general practice, though time consuming, led to the identification of inaccuracies in the list and changes in management. Costs need further evaluation, but if the findings occur widely substantial benefits could be achieved for patients.

Adult↗