Biomedical subjects

L Macleod

Publications and source records attributed to L Macleod.

6 recordsLinked to original sources

PubMed2001

Does general practitioner involvement in commissioning maternity care make a difference?

OBJECTIVES: To evaluate the impact of general practitioners' commissioning of maternity services on women's experiences of care and on resource use, and to consider the implications for primary care commissioning. METHOD: Comparison of women's experiences and resource use between 11 commissioning and 10 non-commissioning general practices. Face-to-face interviews with 212 staff in general practices, National Health Service trusts and health authorities between 1996 and 1998 to establish how maternity care was organised. Women's experience of information, choice, control and resource use obtained by questionnaire mailed 4 weeks post-partum. Data were analysed using multi-level modelling to adjust for case-mix differences. RESULTS: After two reminders, 1957 women (62%) responded to the questionnaire (inter-practice range 52-81%). There were no significant differences in women's experience of care or their resource use between commissioning and non-commissioning practices. Commissioning practices were more likely to be associated with more vertically integrated models of service organisation, but responses to only three of 21 questions about experience of information, choice and control over care, or about resource use, differed between the four models of service organisation identified. CONCLUSIONS: The expectation that giving primary care organisations responsibility for commissioning care will result in improved patients' experiences of care or better use of resources should be treated with caution. The presence of strong national policy may be equally important. Models of service organisation are not proxies for quality of care. The most powerful force shaping patients' experiences of care may be health care professionals' ability to translate national policy into local services.

Continuity of Patient Care↗

PubMed2000

A review of an outpatient paediatric mental health clinic: what we did and what parents thought of it.

OBJECTIVE: To describe the work of a paediatric mental health (PMH) clinic in terms of the types of clients seen and the nature and intensity of interventions used. Also to survey the opinions of parents on issues such as helpfulness and effectiveness, and to tap into issues relating to acceptability and relevance. DESIGN: Retrospective review of case notes covering a one year period and postal client satisfaction questionnaire. SETTING: Children's wing of a large general hospital. SUBJECTS: The case notes of the 54 children referred were analysed. Postal questionnaires were sent to 53 parents of the 41 children who were treated over the targeted 12 months plus a further 12 families who were treated in the six months following. RESULTS: Forty one children with a broad range of paediatric difficulties were treated with their parents. Families were seen relatively promptly after referral and interventions were typically brief involving advice and counselling for parents and most commonly behavioural work with children. The results from the parent satisfaction questionnaire suggested that despite some initial wariness and uncertainty, parents found the clinic to be helpful. A small, but non significant decrease in rated symptom severity was found following treatment, but even in those cases where symptoms persisted or increased, parents still tended to report their experience as being helpful and from their comments seemed to value the clinic. Although parents seemed somewhat intimidated and uncertain of its relevance before attending, their comments suggested that they had benefited from talking about their child's difficulties and gaining understanding within a supportive and friendly environment. CONCLUSIONS: The PMH clinic was found to provide a brief, focused intervention for children and their families which was regarded as helpful by parents, even when the outcome was not necessarily a reduction in symptom severity.

Adolescent↗

PubMed1998

Control cognitions and psychological disturbance in people with contrasting physically disabling conditions.

PURPOSE: This study examines the role of control cognitions, i.e. locus of control (LOC), in predicting adaptation to two contrasting physically disabling conditions. METHOD: Locus of control beliefs were investigated in terms of their relationship with psychological distress (anxiety and depression) experienced by people facing either spinal cord injury (SCI) or multiple sclerosis (MS). The role of pain experience was also considered in terms of its impact on psychological distress in both groups. RESULTS: Results indicated that although SCI subjects were more internally oriented than MS subjects, internality was not linked to lower levels of depression or anxiety in either group, although within the SCI group an external LOC was associated with increased depression and physical disability. CONCLUSIONS: For people facing a future with the challenge of physical disability, the pattern of progression of disability over time may be of significance in the development of psychological distress.

Adaptation, Psychological↗

PubMed1996

Evaluation of client and staff satisfaction with a Goal Planning project implemented with people with spinal cord injuries.

This study assesses client satisfaction and canvasses staff opinions concerning the first year of a Goal Planning rehabilitation programme implemented with in-patients who had sustained a severe spinal cord injury. Questionnaires were completed by 33 patients. As a keyworker system is an integral part of Goal Planning, separate questionnaires were completed by 13 staff/keyworkers. The results indicated that patients believed Goal Planning to be informative about their injury and helpful in promoting a sense of control over their rehabilitation. In addition, a positive, and statistically significant association was found between perceived informativeness and control and the implications for successful rehabilitation are considered. Staff also gave favourable feedback regarding the perceived benefits of Goal Planning for patients, relatives and staff, although they acknowledged the resulting increase in their workload.

Adolescent↗

PubMed1996

How Prepared is Prepared Enough?

A 17-year-old female was in the final stage in treatment of right unilateral cleft lip and palate. She had undergone a number of previous surgeries. Hearing and speech were good on evaluation, and her social and family situation were deemed excellent. After preparatory orthodontics she underwent a Lefort I maxillary advancement. Surgery was successful and she was admitted into postoperative recovery. However, the lack of adequate preoperative preparation caused traumatic reaction from the patient and her parents: anxiety over appearance, crying, refusal of oral fluids and oral care, refusal of analgesia, and refusal to mobilize. The patience and persistence of hospital staff slowly overcame all adversities and the patient moved on to full and successful recovery, but this case prompted changes in preoperative procedures and involvement of patients and their families in postoperative meal selection, planing, and preparation.

Journal Article↗

PubMed1995

The length of the referral chain after failing preschool tympanometry.

AIMS: To describe the time intervals during the process of detection and management of chronic secretory otitis media/glue ear. METHOD: Tympanometry records of 508 preschool children who failed both tympanometry screening and the subsequent retest were examined. Additional information was obtained from 205 parents/caregivers by telephone interview. RESULTS: Calculations of time intervals between tympanometry screening and retesting showed that 75% of children had been retested within 20 weeks and 95% by 40 weeks. Two-thirds (67%) of children had visited their general practitioner within 4 weeks of failing their retest, although 13% had still yet to be seen by 20 weeks. The mean time interval between the initial general practitioner visit and subsequently being seen by an ENT specialist was 20 weeks in the public system compared to 5 weeks if seen privately (p < 0.001). CONCLUSION: The preschool tympanometry screening programme functioned well, although there were delays in retesting 25% of preschoolers. There were substantial time intervals for some children for each link in the referral chain. The reasons for these delays needs investigation to determine how much it is a part of the treatment process and how much due to waiting list problems.

Acoustic Impedance Tests↗