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Jeremy Walker

Publications and source records attributed to Jeremy Walker.

9 recordsLinked to original sources
PubMed2006

Can doctors predict patients' satisfaction and enablement? A cross-sectional observational study.

BACKGROUND: Patient satisfaction surveys are increasingly used to measure consulting quality and outcome, but little is known of how good doctors are at judging their patients' satisfaction with their consultations. OBJECTIVES: To determine if patient satisfaction and enablement following a consultation are correlated with both inexperienced and experienced doctors' predictions of patient satisfaction and doctors' own satisfaction with the consultation. METHODS DESIGN: Cross-sectional questionnaire-based observational study. SETTING: Scottish general practices. MAIN OUTCOME MEASURES: Using a post-consultation questionnaire we compared doctors' estimates of patient satisfaction with the consultation; doctors' own satisfaction with the consultation; scores on the Patient Enablement Instrument (PEI) and the Consultation Satisfaction Questionnaire (CSQ). RESULTS: Twenty-nine doctors and 1848 patients took part. Each doctor recorded an average of 63.7 (SD: 32.1) consultations. Patient measures of satisfaction and enablement were only weakly correlated with doctor predictions of patient satisfaction (rs=0.07 for PEI and 0.13 for CSQ; both P<0.01) or doctor satisfaction (rs=0.10 for PEI and 0.12 for CSQ; both P<0.01) with the consultation. They were, however, moderately well correlated (rs=0.50 P<0.01) with one another. CONCLUSION: Doctors are poor at predicting patient satisfaction in the consultation. Further research is required to determine the reasons for this.

Adult↗
PubMed2005

What happened when Scottish women were given advance supplies of emergency contraception? A survey and qualitative study of women's views and experiences.

The Lothian Emergency Contraception Project in Scotland was a radical intervention in which women aged 16-29 were given 5 packs of emergency contraception (EC) to keep at home. We use survey and qualitative interview data to describe how women used the project packs and their views of advance supplies. The women's accounts suggest that concerns that eased access to emergency contraception will lead to repeated use and risky sex appear to be largely unfounded. Women were pleased to be offered the packs, which were reported as having practical advantages and also sparing them the difficulty of negotiating a sometimes awkward consultation. Respondents explained how they used their packs of EC and in their accounts used justifications, repetition and distancing to emphasise that they would not take risks with contraception or sexually transmitted infections. We interpret the data in the light of the observation that EC has an anomalous role in contraception and the work of applied linguists Candlin and Lucas who have demonstrated the difficulties inherent in the family planning consultation.

Adolescent↗
PubMed2005

Impact of UK colorectal cancer screening pilot on primary care.

BACKGROUND: The UK Colorectal Cancer Screening Pilot has recently been completed to evaluate the feasibility of screening using the faecal occult blood test. Screening will be phased in over the next several years, and it is important to consider the impact on the NHS workforce. AIM: To determine the impact of the UK Colorectal Cancer Screening Pilot on primary care workload. DESIGN OF STUDY: A retrospective survey and prospective audit of general practice staff. SETTING: General practice. METHOD: Workload impact was assessed using a postal questionnaire and a prospective audit of activity in participating practices. Questionnaires were sent to practices that had been involved in the Pilot between 6 weeks and 1 year previously. They were sent to a random sample of 59 practices in Scotland and 60 practices in England between February 2001 and March 2002. Audit forms were sent prospectively to 60 practices involved in the Pilot between May 2001 and September 2002. RESULTS: Sixty-seven per cent of GPs, 82% of practice managers, 69% of practice nurses, and 70% of receptionists responded to the questionnaire. Of 60 practices contacted to take part in the workload audit, 38 returned completed 'workload impact audit' forms. Most practice staff indicated they spent 2% or less of their time during the screening period on Pilot-related activities. Forty per cent of GPs thought that a national colorectal cancer screening programme would substantially impact on the workload in primary care. However, there were variations by country: practice staff in Scotland were more likely to think that it would substantially impact on workload than practice staff in England (44.7% versus 26.6%). CONCLUSIONS: The surveys and audit demonstrate that the Pilot has had a discernible, albeit modest, impact on workload in primary care. Workload of particular significance to primary care personnel includes increases in paperwork, administration, and information provision to patients. The majority of primary care staff support the introduction of a colorectal cancer screening programme. However, there is a strong perception, particularly among GPs, that a national programme of faecal occult blood test screening will impact significantly on workload in primary care, and that primary care-based activities generated through screening should be adequately resourced and remunerated.

Aged↗
PubMed2004

Advanced provision of emergency contraception does not reduce abortion rates.

A number of small studies have demonstrated increased use of emergency contraception (EC) when women have a supply available at home. It has been suggested that widespread use of EC could reduce abortion rates. We undertook a community intervention study designed to determine whether offering advanced supplies of EC to large numbers of women influenced abortion rates. All women aged between 16 and 29 years living in Lothian, Scotland, were offered, through health services, five courses of EC without cost to keep at home. Of a population of around 85,000 women in this age group, the study showed that an estimated 17,800 women took a supply of EC home and over 4500 of them gave at least one course to a friend. It was found that nearly half (45%) of women who had a supply used at least one course during the 28 months that the study lasted. In total, an estimated 8081 courses of EC were used. EC was used within 24 h after intercourse on 75% of occasions. Abortion rates in Lothian were compared with those from three other health board areas of Scotland. No effect on abortion rates was demonstrated with advanced provision of EC. The results of this study suggest that widespread distribution of advanced supplies of EC through health services may not be an effective way to reduce the incidence of unintended pregnancy in the UK.

Abortion, Induced↗
PubMed2004

Do patients and expert doctors agree on the assessment of consultation skills? A comparison of two patient consultation assessment scales with the video component of the MRCGP.

OBJECTIVE: The purpose of this study was to determine whether patient ratings of general practice Registrars' consulting skills are associated with 'expert' scoring using the MRCGP video assessment protocol. METHODS: A cross-sectional observational study of general practice Registrars' consultation skills was carried out in 23 practices in South East Scotland using two types of patient assessment compared with expert assessment of video consultation. The main outcome measures were rank correlation of Registrars' overall level of attainment on the Royal College of General Practitioner (RCGP) video assessment with mean score on the Patient Enablement Instrument (PEI) and mean score on the Consultation Satisfaction Questionnaire (CSQ). RESULTS: The rank correlation of Registrars' mean PEI scores with marks on the RCGP video component was 0.01 (P = 0.97, n = 19) and mean CSQ score 0.05 (P = 0.83, n = 19). There were no adverse comments from patients, but Registrars and trainers found the process onerous. CONCLUSION: No meaningful association was identified between Registrars' score on the RCGP video examination and patient assessment via either the PEI or the CSQ. This suggests that, with regard to measuring quality in the consultation, one or more of the assessments are invalid or that they are measuring different attributes. Further research to elucidate the reasons for the lack of correlation is required.

Clinical Competence↗
PubMed2003

Frequent attendance, socioeconomic status and burden of ill health. An investigation in the west of Scotland.

OBJECTIVES: To investigate whether associations between frequent attendance in general practice and socioeconomic circumstances remain significant after taking detailed account of underlying ill health, perceived social support and social isolation. METHODS: Data from a community health survey of 1477 people in their late forties and late sixties living in the West of Scotland were examined for associations between frequent attendance, socioeconomic circumstances, self-reported ill health and social support using logistic regression. The main outcome measure was the probability of being a frequent attender (defined pragmatically after initial review of the distribution as 10+ visits a year) with 95% confidence intervals. RESULTS: Frequent attendance was significantly associated with: greater numbers of serious conditions reported (adjusted odds ratio 1.47; 99% CI 1.09-1.98); higher levels of anxiety (adjusted OR 1.14; 1.04-1.25); and lower levels of self-assessed health (adjusted OR 0.67; 0.54-0.83). No measures of socioeconomic circumstance or social support remained significantly associated with frequent attendance when the greater burden of ill health in poorer and less well-supported groups was considered. CONCLUSION: The higher levels of frequent attendance likely to be experienced by general practitioners serving populations in adverse social circumstances are likely to be explained by higher levels of health needs, and not solely by a greater readiness to consult for whatever reason. General practitioners working in deprived areas are likely to have to 'run to keep up' in dealing with such comorbidity, and ways of supporting them in the provision of optimum healthcare need to be considered.

Adolescent↗
PubMed2002

Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices.

BACKGROUND: General practitioners (GPs) in the United Kingdom have recently begun to adopt the use of telephone consultation during daytime surgery as a means of managing demand, particularly requests for same-day appointments. However, it is not known whether the strategy actually reduces GP workload. AIM: To investigate how the use of telephone consultations impacts on the management of requests for same-day appointments, on resource use, indicators of clinical care, and patient perceptions of consultations. DESIGN OF STUDY: Randomised controlled trial. SETTING: All patients (n = 388) seeking same-day appointments in each surgery in two urban practices (total population = 10,420) over a four-week period. METHOD: The primary outcome measure was use of doctor time for the index telephone or face-to-face consultation. Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation, frequency of blood pressure measurement and antibiotic prescriptions, and number of problems considered at consultation. Patient perceptions were measured by the Patient Enablement Instrument (PEI) and reported willingness to use telephone consultations in the future. RESULTS: Telephone consultations took less time (8.2 minutes versus 6.7 minutes; diff = 1.5, 95% confidence interval [CI] = 0.6 to 2.4, P = 0.002). Patients consulting by telephone reconsulted the GP more frequently in the two weeks that followed (0.6 consultations versus 0.4 consultations; diff = 0.2, 95% CI = 0.0 to 0.3, P = 0.01). Blood pressure was measured more often in the group of patients managed face-to-face (25/188 [13.3%] versus 12/181 [6.6%]; diff = 6.7%, 95% CI = 0.6% to 12.7%). There was no significant difference in patient perceptions or other secondary outcomes. CONCLUSION: Use of telephone consultations for same-day appointments was associated with time saving, and did not result in lower PEI scores. Possibly, however, this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion.

Appointments and Schedules↗