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Biomedical subjects

J G Howie

Publications and source records attributed to J G Howie.

At least 19 recordsLinked to original sources
PubMed1992

Attaching prices to decision making in general practice.

This paper is an attempt to evaluate the cost implications of decisions made by general practitioners during consultations. Prices were attached to the cost generating decisions of 85 general practitioners in South East Scotland who participated in a 12-month study of their workload. When the price attached to each referral decision was one out-patient attendance, 56 of the 85 general practitioners' costs per consultation were within 15% of the average cost, and 76 were within 25% of the average. However, when the price attached to referral activity was adjusted upwards (to allow for the inclusion of further hospital care), variations between doctors became more pronounced and the decision to refer replaced prescribing as the most important element of variable cost. No important relationships were discovered which linked cost generating activities with characteristics of the doctor or the practice. Implications for fund-holding are discussed.

Costs and Cost Analysis↗
PubMed1992

Attitudes to medical care, the organization of work, and stress among general practitioners.

Eighty five volunteer general practitioners in Lothian region recorded clinical and contextual information on 21,000 consultations during 1987-88. During their recording sessions they reported their perceived levels of stress using a previously validated scale. Subsequently, 80 of the doctors completed a previously validated multi-dimensional scale about their attitudes to patient care. Three attitude subscales (psychological orientation, appropriateness of consultations and responsibility for decisions) correlated with processes of care previously identified as indicators of good care. The 20 doctors who scored most highly on these patient-centred scales recorded self-perceived stress in 27% of their consultations compared with 11% of the consultations of the 33 doctors who scored lowest on these scales. Among the 20 most patient-centred doctors those booking patients at eight patients per hour or more reported stress at twice as many consultations as those with a longer booking interval; doctors whose preferred working styles conflicted with their booking patterns reported stress in up to 62% of consultations. Doctors with a higher patient-centred orientation find their work more stressful. Longer booking intervals remove much of that stress, particularly when doctors' preferred style of consulting requires them to spend more time at individual consultations. Previously described work stressors offer a theoretical explanation for a problem which is important for both doctors and patients.

Adult↗
PubMed1992

Social indicators of health needs for general practice: a simpler approach.

The ability of different measures of socioeconomic position to predict distress in a sample of general practice attenders has been examined. Perceived distress was measured using the Nottingham health profile. The measures of socioeconomic position included: social class, Jarman scores of patients' areas of residence, whether or not patients owned their own home, whether or not patients owned a car, whether or not they had been unemployed during the previous year and whether or not they had had further education. Social class data were only available for 84% of the 1075 respondents completing the Nottingham health profile. Those respondents for whom social class data were not available were significantly more likely to score positively on the social isolation, sleep and physical mobility dimensions of the Nottingham health profile. Not owning one's own home emerged as the measure of socioeconomic status that best predicted distress. The other measures of socioeconomic status that were significantly predictive of distress were not having had further education and having been unemployed during the last year. Different measures of socioeconomic position significantly predicted positive scores on different dimension of the Nottingham health profile. Although the Jarman score significantly predicted a positive score on the sleep dimension, it did not predict distress well when compared with the direct measures of disadvantage. There are simple, more direct measures of socioeconomic position than social class that could be collected routinely by practices which would form a better basis for the evaluation of services required to target those needs created by persisting social inequalities in health.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Changes resulting from increasing appointment length: practical and theoretical issues.

The experience of one urban teaching practice in changing its appointment length from 7.5 to 10.0 minutes is described. Observed benefits to patients attending routine surgeries included an increased consultation time (mean 8.6 minutes before, 9.1 minutes after) and reduced waiting time (mean 19.1 minutes compared with 14.6 minutes). Overall, workload was unchanged but improving the 'fit' between supply and demand was associated with loss of flexibility--a greater number of extra patients required to be seen, apparently because fewer appointments were available at the start of each day. Waiting and consultation times in teaching surgeries and trainee surgeries (booked throughout at 10.0 minute intervals) were unchanged in response to the new arrangements. The changes introduced were well received by medical and reception staff although their response was not formally measured. Planning the organization of an appointment system requires several distinct decisions to be made. The preferred or actual average length of consultations has to be decided and booking arrangements designed to enable this to take place without the doctors persistently running over time. The number of appointments per week required to meet anticipated demand has to be calculated on the basis of list size and expected annual consultation rate. However, an exact fit between supply and demand will lead to congestion of the system and it appears that flexibility in the form of an overprovision of appointments to projected demand of about 120% should be built in. Sufficient vacant slots must be provided at the start of each day to allow sufficient flexibility to avoid excessive numbers of patients having to be accommodated.(ABSTRACT TRUNCATED AT 250 WORDS)

Appointments and Schedules↗
PubMed1992

The chief scientist reports ... The Scottish general practice shadow fund-holding project--outline of an evaluation.

After the agreement in January 1989 between the Minister of Health at the Scottish Office, Mr Michael Forsyth, and six groups of General Practitioners (GPs) in the Grampian and Tayside Regions of Scotland to embark on a 'shadow fund-holding' project, the Government agreed to promote an independent evaluation of the scheme. As a result, the Department of General Practice at Edinburgh University was invited to present plans to evaluate the working of and results of the scheme. Consultations with the Minister and Health Department officials, the general practices concerned, and staff of the two Health Boards involved took place during the first three months of 1990, and an outline protocol for the evaluation was approved and funded through the Chief Scientist Organisation for a three-year period from April 1990. It was agreed by all involved that piecemeal publications of results during the period of the research would be inappropriate, but with other attempts to evaluate fund-holding now being reported elsewhere in the UK, it has been agreed that an outline of issues being explored and the methods being used would be in the general interest. This paper first outlines the principal areas in which the evaluation is being focused, then describes the general methods being used, and finally comments on some of the problems encountered with the evaluation. The project should be seen as a descriptive beginning to what may well be a period of around a decade needed to appreciate the full implications of any major change in the organisation of health service provision.

Family Practice↗
PubMed1991

Jarman index.

Explore the source record for details and available documents.

Health Services Needs and Demand↗
PubMed1991

A measure of perceived health in evaluating general practice: the Nottingham Health Profile.

The paper describes two ways in which the Nottingham Health Profile (NHP) may be useful in evaluating general practice: it can provide useful and relevant information about the needs of patients, and can also be used to evaluate outcome by examining the relationship between changes in perceived health status before and 4 weeks after a consultation in relation to care received during that consultation. Findings are based on a sample of 1979 consulters who completed the Nottingham Health Profile prior to consultation and 732 consulters aged 16 years who also completed a Nottingham Health Profile 4 weeks after consultation. Comparisons are made according to the age, sex and illness status of the consulters, length of consultation and psychosocial care received. As a measure of need, significant differences were found in the health profile according to age, sex and illness status, length of consultation and doctors perception of the presence of relevant psychosocial issues. The only variable which was significantly related to short-term outcome was reported presence of a long term illness relevant to the consultation. The NHP is shown to have shortcomings as a measure of outcome for a cross-section of general practice consulters; it is, however, useful in demonstrating how processes of care relate to need in general practice.

Adolescent↗
PubMed1991

Factors influencing waiting times and consultation times in general practice.

Using data collected from 85 general practitioners in Lothian, large variations were found in the time patients wait for and spend with their doctor. This study, which sets consultations into their administrative framework, examines factors which cause this variation. Consultation time was found to be affected by the total number of patients attending a particular surgery, while waiting time was found to be affected by an individual patient's place within that surgery queue. Taking these two results together suggests that patients seen at the end of large surgeries are likely to get a different service from their doctor than they would have done earlier in the session, or when attending a less busy surgery. Possible strategies are discussed for reducing average waiting times, thereby decreasing the relative cost of consultation to patients.

Appointments and Schedules↗
PubMed1991

Long to short consultation ratio: a proxy measure of quality of care for general practice.

Eighty five general practitioners in the Lothian region recorded information on all surgery consultations on one day in every 15 for a year. On the basis of their mean consultation times with patients the working styles of the general practitioners were described as 'faster' (n = 24), 'intermediate' (n = 40) or 'slower' (n = 21). The 21,707 consultations which they carried out over this period were defined as 'short' (five minutes or less), 'medium' (six to nine minutes) or 'long' (10 minutes or more). Independent of doctor style, 'long' consultations as against 'short' consultations were associated with the doctor: (1) dealing with more of the psychosocial problems which had been recognized and were relevant to the patient's care; (2) dealing with more of the long term health problems which had been recognized as relevant; and (3) carrying out more health promotion in the consultation. Patients also reported greater satisfaction with longer consultations. The ratio of long:short consultations was found to be 0.28:1 for 'faster' doctors as against 2.3:1 for 'slower' doctors. When doctors in either group had more heavily booked surgeries or were running late, the long:short consultation ratio fell, in some cases by over 50%. This paper suggests that the ratio of long to short consultation length for a general practitioner might become the basis of a simply proxy measure of quality of care; and that its use might help monitor the effect of recent and proposed changes in the way in which general practice care is delivered.

Appointments and Schedules↗
PubMed1989

Quality and the use of time in general practice: widening the discussion.

To examine the association between different consulting styles in general practice (defined according to the average length of doctor-patient contact time in surgery consultations) and the process of care for those patients presenting with new episodes of respiratory illness, 1787 consultations conducted by 85 general practitioner principals in Lothian from November 1987 to May 1988 were analysed. Short as against long consultations resulted in less attention being given to psychosocial issues that the doctor recognised as relevant. When psychosocial problems were dealt with prescribing of antibiotics decreased. In this volunteer sample of doctors the process of care seemed to reflect decisions as to how time was allocated rather than inherently different patterns of clinical behavior. Organisational and contractual changes will shift the mix of financial and professional incentives for general practitioners in ways that could lead to doctors reallocating their time toward shorter consultations; such a reallocation could have important implications for patient care.

Anti-Bacterial Agents↗
PubMed1988

Involving the patient in reporting adverse drug reactions.

A method is described for increasing the level of reporting of adverse drug reactions. Patients prescribed a black triangle drug (one being monitored by the Committee on Safety of Medicines) were given a leaflet by the dispensing chemists in one town, encouraging them to report any adverse reaction to their doctor. Over two two-month periods, reports of adverse reactions rose from six out of 576 in the control period (10 per 1000) to 11 out of 481 (23 per 1000) in the study period but only one 'yellow card' was submitted to the Committee on Safety of Medicines.

Drug-Related Side Effects and Adverse Reactions↗