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Biomedical subjects

M Ashworth

Publications and source records attributed to M Ashworth.

At least 19 recordsLinked to original sources
PubMed2002

Prescribing indicators and their use by primary care groups to influence prescribing.

OBJECTIVE: To examine the prescribing incentive schemes used by primary care groups (PCGs); to determine the prescribing indicators used under these schemes; and to assess whether the schemes were seeking to improve the quality of prescribing as well as controlling prescribing costs. DESIGN: Cross-sectional survey. SETTING: A total of 145 PCGs in the London and South-East NHS regions. PARTICIPANTS: Prescribing advisers in each PCG. METHODS: Descriptions of the prescribing indicators monitored by each PCG were obtained from a questionnaire survey of PCGs at the end of the 1999-2000 financial year. Financial information on prescribing and details about the implementation of prescribing incentive schemes for this period became available 6 months later and were obtained by a further questionnaire, follow-up telephone and E-mail surveys. OUTCOME MEASURES: Prescribing indicators, prescribing budgets and spend. RESULTS: One hundred and twenty-one out of 145 (83%) PCGs replied to the questionnaires about prescribing indicators and 129 out of 145 (89%) replied with details about their prescribing costs. The most frequently monitored prescribing indicator was generic prescribing, used by 106 out of 121 (88%) PCGs. The most frequently used clinical areas for prescribing indicators were antibiotics (76% of PCGs), gastro-intestinal prescribing (68%), non-steroidal anti-inflammatories (37%) and cardiovascular prescribing (32%). Seventy-six (63%) schemes also used non-prescribing analysis & cost (PACT) based data for their incentive schemes such as information from prescribing audits and reviews of repeat prescribing protocols. Only 33 (23%) had reached agreement with their practices enabling all prescribing indicator information to be disseminated on a named basis to allow practices to examine each others' prescribing data. CONCLUSIONS: Prescribing incentive schemes usually include targets for improvements in prescribing quality as well as cost. PACT-based data were used for cost control and quality improvement but non-PACT data were almost entirely used to promote prescribing quality improvements. The validity of non-PACT data was questioned as was the choice of some indicators that appeared to have been selected without full consideration of current expert opinion. Further work is needed on which indicators are most likely to act as catalysts to prescribing change.

Drug Prescriptions↗
PubMed2002

The effects on GP prescribing of joining a commissioning group.

BACKGROUND: It is not known to what extent general practitioners (GP) can change their prescribing upon joining a commissioning group and what features of a commissioning group may promote prescribing change. The opportunity to study potential prescribing change arose with the formation of a limited number of Primary Care Commissioning Groups (PCCGs), a precursor of Primary Care Groups (PCGs) and Primary Care Trusts (PCTs). METHODS: This was a controlled study of general practice prescribing costs. All practices (n=24) within one inner city PCCG were compared with matched controls that were not part of a PCCG. Cross sectional survey data was collected from the PCCG practices to determine possible reasons for prescribing change. RESULTS: The total annual prescribing cost rose by 4.0% in the PCCG practices and by 6.9% in controls (P=0.01). Significant cost containment was found for gastrointestinal prescribing (P=0.03), attributable to differences in the cost of proton pump inhibitors (PPIs) which fell by 0.7% in the PCCG but rose by 7.3% in controls (P=0.03). Total relative savings in the PCCG practices amounted to around pound 220,000. General practitioners making the greater savings in PPI costs within the PCCG, were more likely to report being influenced by information from the prescribing adviser. CONCLUSION: General practice prescribing costs were contained to a greater degree in practices participating in the PCCG. The differences in gastrointestinal prescribing were most marked for PPIs which were specifically targeted by the prescribing adviser. The GPs themselves attributed their own prescribing change to information provided by the prescribing adviser. Other factors operating within the PCCG may also have influenced prescribing such as a more locally based management system, different financial incentives and a greater degree of co-operative working amongst GPs.

Contract Services↗
PubMed2001

Sphygmomanometer calibration: a survey of one inner-city primary care group.

Sphygmomanometers are the cornerstone of blood pressure management and yet there is no national standard for the regulation of this equipment in the UK. It is known that these machines may often be inaccurate, particularly those used in the community. We embarked upon a survey of all sphygmomanometers in current use in one inner city primary care group. Contrary to our initial hypothesis, inaccuracy rates were lower than in other reported community surveys with 2.3% of mercury and 14.8% of anaeroid sphygmomanometers failing the test. Surprisingly, inaccurate machines did not cluster in the less well developed practices. The implication is that all practices need to have procedures in place for the regular calibration of their sphygmomanometers.

Calibration↗
PubMed2001

Non-Epstein-Barr virus-associated T-cell lymphoma following cardiac transplantation for Barth syndrome.

UNLABELLED: Barth syndrome is a metabolic disease characterized by infantile cardiomyopathy, neutropenia and organic aciduria. We report disease evolution in one of the first affected boys to undergo successful cardiac transplantation. CONCLUSION: Although cardiac status stabilized, he developed disabling skeletal myopathy, protracted lymphopenia and--5 y after transplant--fatal Epstein Barr (EBV)-negative T-cell non-Hodgkin's lymphoma.

Cardiomyopathy, Dilated↗
PubMed2000

Motivating general practitioners to change their prescribing: the incentive of working together.

OBJECTIVE: To determine the extent to which GPs were motivated to change their prescribing upon joining a Primary Care Commissioning Group (PCCG) and how effective certain interventions planned by the PCCG might be as a means to change prescribing. To define the characteristics of GPs less motivated to change their prescribing. DESIGN: A cross-sectional survey of participating general practitioners linked with current prescribing information derived from PACT data. SETTING: General practice covering a geographical locality within inner-city south London. SUBJECTS: All 72 general practitioners who had joined a GP Commissioning Group. MAIN OUTCOME MEASURES: questionnaire responses. RESULTS: 93% of GPs entering the GP Commissioning Group expected their prescribing to change but none expected substantial change. There was no difference between fundholders, singlehanders nor training practices in their expectation of change. GPs in practices with the lowest quality prescribing, as measured by a quality index, were least likely to expect change (Spearman's r = 0.25, P = 0.04). Those in practices with higher prescribing costs were not more likely to expect their prescribing to change, whereas expensive prescribers who were unaware of their practices' prescribing costs were associated with a reduced expectation of prescribing change (P = 0.05). Educational interventions were thought to be the most effective means by which prescribing could be changed, whereas formularies and financial factors were perceived as weaker influences. CONCLUSION: Acceptance of a cash-limited prescribing budget by GPs is accompanied by the expectation of personal prescribing change. The motivation to change prescribing may be related to a strongly developed collectivist perspective amongst GPs who are prepared to consider the prescribing implications for their fellow GPs. It is ironic that those with the least expectation of change should have the lowest quality prescribing, or be unaware of their high cost prescribing. Engendering greater commitment to the professional group may be one way of changing their prescribing.

Adult↗
PubMed2000

When questionnaire response rates do matter: a survey of general practitioners and their views of NHS changes.

This paper investigates whether general practitioners (GPs) who do not participate in questionnaire surveys (non-responders) hold different views on participation in primary care reorganisation than their more compliant colleagues. A survey of 72 GPs' involvement in a pilot primary care prescribing group elicited an initial response of 74%. Non-responders were then approached personally and persuaded to complete the questionnaire. Comparison of the responders and the non-responders showed that the latter did differ significantly from the responders in many of their views. This difference needs to be considered whenever the results of surveys are used to guide policy-making in the more corporate model of primary care that is now emerging.

Attitude of Health Personnel↗
PubMed1999

Unilateral agenesis of the diaphragm: a separate entity or an extremely large defect?

Since the mid-1980s, unilateral agenesis of the diaphragm (DA) has attracted the attention of paediatric surgeons as more babies affected by this extreme form of congenital diaphragmatic hernia (CDH) survive. Some authors believe that it represents a separate clinical entity. We undertook a retrospective analysis of all babies with CDH treated in the South-West Regional Paediatric Surgical Centre in Bristol between 1981 and 1995. Of 108 babies 16 (14.8%) were identified as having DA. All presented with severe respiratory distress from birth. In comparison to the group of patients with postero-lateral hernia, neonates with DA had lower Apgar scores and required longer preoperative stabilisation with inotropic support and vasodilators. Nine were subjected to operation and all required diaphragmatic replacement. Only 3 survived; thus, mortality in the DA group was 81.25%, and among those who underwent surgery 66.6% The same data for babies with postero-lateral hernia were 15.2% and 7.2%, respectively. Our results indicate that DA is associated with high morbidity and mortality, but we have not found any evidence that this anomaly is a distinct entity. In addition, we reviewed all post-mortem reports of fetuses with diaphragmatic defects available for the same period. Of 19 fetuses, 10 (52.6%) had DA. The morphological details of the diaphragmatic defect and the presence of associated anomalies were analysed. Our observations support the hypothesis that DA occurs in the very early stages of embryonic life and may be attributed to developmental arrest of the septum transversum.

Diaphragm↗
PubMed1999

Sources and implications of dissatisfaction among new GPs in the inner-city.

OBJECTIVES: We aimed to examine the factors that were most stressful for new principals in inner-city general practice. In addition, given the concerns about retention of new principals, to ascertain whether high perceived stress translated into regret that they had joined their practice and factors that might protect from regret. METHODS: A questionnaire survey, within an inner-city Health Authority. The subjects were 101 GPs appointed as principals between 1992 and 1995. RESULTS: Eighty-three out of 101 GPs replied. The greatest sources of stress were, in order, patient expectations, fear of complaint, out-of-hours stress and fear of violence. Although these stresses were scored highly, 61% expressed no regret at having joined their practice with just 4% reporting considerable regret. Stress within the partnership and stress arising from patient expectations accounted for 23% of the variation in regret. Holders of the MRCGP were significantly protected against regret; there was no evidence that other factors such as medical positions outside the practice, membership of a young principals support group, fundholding status or training practices offered significant protection against regret. CONCLUSION: Despite reported difficulties in recruiting new young principals to the inner-city-and despite their reported high levels of stress-few have regrets about their decision to join their practice. For those who did regret joining their practice, the three principal associations were partnership stress, patient expectations and not possessing the MRCGP. Each of these factors may be amenable to intervention by policies geared to improve GP retention.

Adult↗
PubMed1997

Congenital malignant rhabdoid tumour of the gum margin.

The case of an infant born with a large polypoid tumour arising from the mouth is described. The tumour had the histological, immunohistochemical and ultrastructural phenotype of an extrarenal malignant rhabdoid tumour and followed an aggressive clinical course. This is one of the few reported cases of malignant rhabdoid tumour to present at birth. The oral tumour was associated with a mass in the posterior cranial fossa. This was most likely to be a simultaneous second primary tumour.

Fatal Outcome↗
PubMed1995

Withdrawal of triazolam's product licence: effect on patients 18 months later.

The product licences for triazolam in Britain were suspended in October 1991. We aimed to determine whether the sudden withdrawal of a benzodiazepine from the market constitutes a major impetus for patients to reduce or stop their benzodiazepine consumption. Patients in 10 London general practices who were prescribed triazolam in the 12 months prior to the withdrawal of its licence were interviewed. Data from written and computerized general practice records were also studied. One hundred and forty-seven patients were identified, of whom 107 (73%) were interviewed; 38 were chronic users; 68 patients had a history of serious physical illness while 33 had a history of psychiatric problems; 45% of chronic and 66% of intermittent triazolam users had stopped receiving prescriptions for benzodiazepines from 6 months after the withdrawal of triazolam's licence up to 18 months later. Only 12 (11%) recalled suffering significant withdrawal effects. We conclude that official action to curb prescribing of a benzodiazepine acts as an important stimulus for patients to reduce or stop their use of all psychotropic medication without increasing psychological morbidity or leading to unacceptable side effects.

Adult↗
PubMed1994

Controlled evaluation of brief intervention by general practitioners to reduce chronic use of benzodiazepines.

BACKGROUND: It is recommended that long-term users of benzodiazepines in general practice be withdrawn from their medication where possible. AIM: A study was undertaken to assess the effectiveness of minimal intervention delivered by general practitioners in helping chronic users of benzodiazepines to withdraw from their medication, and to determine the psychological sequelae on patients of such intervention. METHOD: Patients taking benzodiazepines regularly for at least one year were recruited by their general practitioner and allocated either to a group receiving brief advice during one consultation supplemented by a self-help booklet or to a control group who received routine care. The patients completed the 12-item general health questionnaire and a benzodiazepine withdrawal symptom questionnaire at the outset of the study and at three and six months after this. RESULTS: Eighteen per cent of patients in the intervention group (9/50) had a reduction in benzodiazepine prescribing recorded in the notes compared with 5% of the 55 patients in the control group (P < 0.05). In the intervention group, 63% of patients had a score of two or more on the general health questionnaire at baseline compared with 52% at six months. Of the 20 intervention patients reporting benzodiazepine reduction, 60% had a score of two or more at baseline compared with 40% at six months. Intervention patients had significantly more qualitative, but not quantitative, withdrawal symptoms at six months compared with baseline. Consultation rates were not increased in the intervention group. CONCLUSION: The study indicates that some chronic users can successfully reduce their intake of benzodiazepines with simple advice from the general practitioner and a self-help booklet. This type of intervention does not lead to psychological distress or increased consultation.

Adult↗