PubMed Health⌕ Search

Biomedical subjects

P J Ayres

Publications and source records attributed to P J Ayres.

7 recordsLinked to original sources
PubMed1996

Rationing health care: views from general practice.

General practitioners (GPs) in the United Kingdom are central to the commissioning of health care services. A qualitative study of their views was therefore designed, which incorporated an in-depth (open) interview technique carried out on a 20% sample of all GPs (n = 100) in one United Kingdom Health District. The data from these interviews indicated that GPs were aware of, but had mixed feelings about the need for rationing. They expressed disquiet about the dilemma faced in rationing health care at the time of the consultation and readily associated issues of cost in their practice with rationing. Some of the currently adopted methods of rationing (waiting lists, co-payments and ability to pay) were commented upon. The respondents also made suggestions on how rationing could be carried out, which included: maximizing efficiency to reduce the need for rationing; using a third party committee to make rationing decisions, with a membership of clinicians, managers, and possibly public representatives, and; being explicit about how rationing is done. Fundholding brought rationing decisions to the fore, and worried most who discussed it in the context of rationing. The conclusion of this paper is that current implicit rationing policies in the National Health Service are flawed as they assume that GPs will ration health care at the time of the consultation. The involvement of GPs in the rationing process is important (particularly given the present expansion of GP fundholding), so there is a need for an alternative to the present system.

Adult↗
PubMed1996

Practical public health in a primary care setting. Discrete projects confer discrete benefits but a long-term relationship is needed.

Investigates a mechanism for delivering public health advice in a primary care setting--three West Yorkshire general practices--by seconding a public health physician (PHP) to each practice for six months, each practice receiving one day per week. Describes how the topics to be addressed--developing a practice plan for managing information; improving services available for Asian patients; and exploring "value for money" in fundholding--were chosen. Details the procedures and lists the main outcomes. Concludes that placing a public health physician in practices may not be the optimal approach for transferring public health knowledge, but topics important to the practice lend themselves to such an intervention, with potential long-term benefit for public health and primary care.

Family Practice↗
PubMed1995

Major chemical incidents--a response, the role of the Consultant in Communicable Disease Control and the case of need for a national surveillance-resource centre.

BACKGROUND: The aim of this study is to discuss the adequacy of current arrangements for dealing with major chemical incidents through the offices of the Consultant in Communicable Disease Control (CCDC). METHOD: This paper describes the public health response to an explosion at a chemical works which was followed by illnesses of unknown aetiology in emergency service workers and other people. An outline of the circumstances as they presented themselves and a description of the lessons learned from the management of this disaster are presented alongside an overview of the prevailing infrastructure of advice, support and training available to CsCDC. Key issues relevant to these areas are discussed. RESULTS: A total of 181 potential cases were notified to the investigating team, of whom 115 had an illness possibly associated with the explosion. Of these, 93 suffered a gastrointestinal illness and 68 had so-called 'toxic' symptoms (eye, skin and bronchopulmonary irritation). Forty-six people had both sets of symptoms at the same time. CONCLUSIONS: Current arrangements dictate that public health physicians have a role in incidents such as this, whether they seek such a position or not. The specialty would do well to consider developing formal disaster training schemes for those likely to have to manage major incidents (usually the CCDC), and would benefit from the setting up of a chemical-environmental incident surveillance-resource centre. Such a centre should have a remit for teaching and training, information support, incident recording, coordination of expert resources, and liaison between interested bodies both nationally and internationally.

Chemical Industry↗
PubMed1994

Prioritizing services: GPs' views, fundholders versus non-fundholders.

Aims to assess the level of agreement between priorities of service provision in 20 discrete clinical areas, as laid out in a district health authority (DHA) purchasing plan, and the views of GPs in the catchment area of that authority and to test for a statistically significant difference between the views of fundholding and non-fundholding GPs. A 74 per cent response rate was achieved, and analysis suggested that local GPs' views were broadly in line with their DHA strategy, and that a significant difference existed between the views of fundholders and non-fundholders in only one treatment area, namely that of lithotripsy. Concludes that the postal questionnaire is a cheap and easy method of assessing the views of GPs on prioritizing issues. As yet there is little difference between fundholding and non-fundholding GPs in this area of decision making.

Attitude of Health Personnel↗
PubMed1978

Assessment of the skin penetration properties of different carrier vehicles for topically applied cortisol.

Four commercially available topical preparations of cortisol, Alphaderm, Calmurid HC, Efcortelan and Topisone, had trace quantities of tritiated cortisol added to them. The resultant radiolabelled creams were applied to the dorsum of the pig and the penetration of the steroid was assessed. Alphaderm was shown to deliver approximately 16.0 times more cortisol to the skin than Topisone, approximately 8.0 times more than Efcortelan and approximately 3.0 times more than Calmurid HC.

Administration, Topical↗