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Biomedical subjects

J Silcock

Publications and source records attributed to J Silcock.

13 recordsLinked to original sources
PubMed2004

Lateral epicondylalgia: a problem for rural workers.

Lateral Epicondylalgia (LE) (tennis elbow) is a problematic condition for workers in labour intensive industries. The economies of many rural communities are founded on industries such as grape growing, meat and fish processing, fruit processing and winemaking. Workers in those industries are at increased risk of developing work-related upper limb mechanical disorders, including LE. This article reviews current understanding of the aetiology and management of this common condition as an aid to rural health professionals managing this presentation. A variety of treatment options exist for the management of LE with the literature divided on which approach is most effective. However, there is evidence that exercise is a key component of a management strategy. In addition to the current practice of prescribing exercises for the wrist extensor muscles, recent research suggests that appropriate activation of the stabilising muscles of the shoulder and cervical spine also needs to be considered by the rural practitioner.

Journal Article↗
PubMed2001

The impact of the pharmacist on an elective general surgery pre-admission clinic.

OBJECTIVE: A traditional clinical pharmacy service for surgical patients involves a ward visit that identifies and responds to issues after prescribing has taken place. It was hypothesised that pharmacist involvement in a general surgery pre-admission clinic (PAC) would provide elective patients with significantly better pharmaceutical care than ward visits alone. METHOD: 100 elective general surgery patients were recruited into 2 groups as part of a non-randomised controlled trial. The groups were comparable in terms of age, surgical procedure and use of medicines. The control group received standard ward visits. The intervention group had pharmaceutical assessment in a pre-admission clinic. This assessment incorporated pharmacist-led drug history taking and prescription transcription. OUTCOME MEASURES: Number, classification and clinical significance of pharmaceutical interventions. RESULTS: A pharmacist made 76 interventions in the PAC group and 79 interventions in the ward group. No prescribing errors and omissions were made in the PAC group. The clinical significance of PAC interventions was rated more highly than ward interventions on two scales. Involvement in the PAC increased the pharmacist's workload, but saved time for surgical and nursing staff. Surgical and nursing staff identified writing discharge prescriptions as the most valuable service provided by the PAC pharmacist. CONCLUSION: By ensuring safe prescribing in the PAC group, the pharmacist was able to become more involved in clinical issues. Pharmacist involvement in PACs presents a useful opportunity for expansion of pharmacy services. However, extra resources would be needed in order to provide these services fully.

Aged↗
PubMed1999

Economic evaluation of pharmacy services--fact or fiction?

Previous attempts to conduct economic evaluation of pharmacy services are almost exclusively from the US and the UK. Studies from the US concentrate largely on the drug cost savings realised by pharmacists. Few detail the costs of service provision and even fewer give an estimate of service benefits other than decreased drug expenditure. UK evaluation to date focuses on quantifying pharmacists' interventions, but there is no clear indication of the quality or the impact of these. This article proposes a model for economic evaluation and discusses the factors which make evaluation results useful to decision makers. The costs and outcomes, that need to be considered for economic evaluation, are discussed and the example of a pharmacist led anticoagulation clinic is used. The nature of modern health care systems demands that services are effective and, increasingly, cost-effective. If pharmacy as a profession is to develop, decision makers must decide that pharmaceutical care delivered by pharmacists is a cost-effective use of health care resources. Politics, education and cost pressures will mean that decision makers are likely to put more weight on the results of economic evaluation in future. If pharmacists do not start to provide good quality data about the costs and outcomes of pharmacy services then other evaluators will.

Clinical Trials as Topic↗
PubMed1998

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland.

OBJECTIVE: To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model. DESIGN: A randomised controlled trial of community pharmacies and pharmacy customers. SETTING: All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited. SUBJECTS: All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%). MAIN OUTCOME MEASURES: The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months. RESULTS: The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p < 0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as "very useful" (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months' continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months' continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering. CONCLUSIONS: The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.

Adolescent↗
PubMed1997

An economic evaluation of thrombolysis in a remote rural community.

OBJECTIVES: To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis. DESIGN: Economic evaluation based on the results of the Grampian region early anistreplase trial. SETTING: 29 rural general practices and one secondary care provider in Grampian, Scotland. SUBJECTS: 311 patients recruited to the Grampian region early anistreplase trial. INTERVENTIONS: Intravenous anistreplase given either by general practitioners or secondary care clinicians. MAIN OUTCOME MEASURES: Survival at 4 years and costs of administration of thrombolysis. RESULTS: Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of 425 pounds per patient. This gives a marginal cost of life saved at 4 years of 3,890 pounds (1,990 pounds to 42,820 pounds). CONCLUSIONS: The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.

Anistreplase↗
PubMed1997

A comparison of smokers' and ex-smokers' health-related quality of life.

BACKGROUND: The aim of the study was to assess the difference in health status between current smokers and ex-smokers of five years or greater standing. METHODS: A group of current smokers and a group of ex-smokers (of five years or greater standing) in Aberdeen, north-east Scotland, were each sent a postal questionnaire containing SF-36, EuroQol, condition-specific and socio-demographic questions. The subjects were 3000 adults (1500 smokers, 1500 ex-smokers) randomly selected from the records of nine general practices. The main outcome measures were the eight scales within the SF-36 health profile, EuroQol tariff scores and assessment of respiratory symptoms. RESULTS: Smoking cessation leads to an improvement in a range of respiratory symptoms and health-related quality of life. However, in some cases other socio-economic characteristics are better indications of quality of life than smoking status. CONCLUSIONS: Smoking cessation leads to a significant improvement in a range of respiratory symptoms. There appear to be significant differences between smokers' and ex-smokers' perceived quality of life. However, these differences are relatively small and in the majority of cases are better explained by variation in age, housing and economic status. When promoting smoking cessation to patients it is possible to highlight expected improvements in respiratory symptoms, impact on global quality of life and longer-term disease effects.

Adult↗
PubMed1997

The cost of medicines in the United Kingdom. A survey of general practitioners' opinions and knowledge.

Prescribing costs in general practice continue to grow. Their importance is underlined by the amount of information concerned with costs that general practitioners (GPs) receive, and by the existence of target budgets. In 1986 and 1991, surveys showed that GPs agreed that cost should be borne in mind when choosing medicines, but that their knowledge of drug prices was often inaccurate. This study assessed the current knowledge and attitudes of GPs in the UK in respect of prescribing costs, and examined the influence of various developments in general practice since 1986 on the accuracy of drug price estimation. 1000 randomly selected GP principals (500 in Scotland and 125 in each of 4 English health regions) were sent a postal questionnaire. The GPs' level of agreement with 5 statements concerned with prescribing costs, and the accuracy of their estimates of the basic price of 31 drugs, were analysed. Most GPs (71%) agreed that prescribing costs should be taken into account when deciding on the best treatment for patients. Fundholders were more likely than non-fundholders: (i) to agree that prescribing costs could be reduced without affecting patient care; (ii) to agree that providing more information on costs would lower the cost of prescribing; and (iii) to comment that cost guidelines had changed their prescribing habits. Fundholders were less likely than non-fundholders to reject the principle of fixed limits on prescribing costs. Overall, one-third of the price estimates given were accurate (within 25% of the actual cost). For the most expensive drugs in the survey [those priced over 10 pounds sterling (Pound) per pack], half of the price estimates were accurate. There were significant differences between non-fundholders' and fundholders' estimates of the price of less expensive drugs (those priced at less than 10 pounds per pack). Use of a formulary or computer-displayed drug price information did not affect the accuracy of price estimates. It may be that GPs who were more knowledgeable and concerned about costs were more likely to become fundholders. It is also possible that the expansion of fundholding, or other mechanisms that give GPs responsibility for resource allocation, might improve accurate cost awareness in prescribing. Clinical and economic review of repeat prescribing is recommended.

Cost-Benefit Analysis↗
PubMed1996

The 1990 GP contract--meeting needs?

This paper reviews the empirical evidence about the effects of the 1990 general practitioner (GP) contract on the provision of medical services in the United Kingdom. A brief outline of the major changes instigated by the 1990 GP contract is given. Studies of the implementation of the changes tend to focus on either trend analysis, cost-effectiveness or medical practice variation. These studies are reviewed and the implications for the efficiency of primary health care are discussed.

Aged↗
PubMed1994

Evaluation of costs.

Explore the source record for details and available documents.

Cost-Benefit Analysis↗
PubMedDate not supplied

The 1990 GP contract: modelling variation in minor surgery provision.

Logistic regression was used to determine the extent to which general medical practices undertake the maximum amount of minor surgery activity allowed for in the GP contract. Data on activity for 89 practices in the Grampian region of Scotland was available for two consecutive financial years: 1992-93 and 1993-94. Comparison of the regression models developed in each year showed that rural location and practice size were consistently associated with the maximization of minor surgery activity under the terms of 1990 GP Contract. In 1993-94 practices with a greater proportion of deprived patients were also more likely to be 'maximizers'. Quantitative modelling allows the performance of GPs to be assessed and also helps to identify factors which are a barrier to service development. It seems likely that, in Grampian, GPs who were able to exploit fully the provisions of their contract were those whose patients had the greatest capacity to benefit from minor surgery. Currently the GP contract is nationally negotiated, but in the future local negotiated remuneration is likely to become widespread. Modelling will have an important role in the design and monitoring of incentive structures, and help to ensure that service provision equates to local needs.

Contract Services↗