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P Kinnersley

Publications and source records attributed to P Kinnersley.

At least 37 records · Page 2Linked to original sources
PubMed1998

Reducing antibiotics for respiratory tract symptoms in primary care: consolidating 'why' and considering 'how'.

We summarize recently published evidence showing that antibiotic treatment offers little or no benefit to most patients presenting with sore throats, acute otitis media, maxillary sinusitis, and acute bronchitis. Despite this research, the prescription of antibiotics for respiratory tract conditions is rising in Britain. This wastes money, encourages people to consult for self-limiting conditions, and causes bacteria to become resistant to antimicrobials. Ways of changing present practice are underresearched. Enhanced consulting skills, guidelines and monitoring strategies, patient education, and anti-inflammatory drugs for recurrent and chronic sufferers all hold promise.

Anti-Bacterial Agents↗
PubMed1997

Measuring general practice-based primary care: generic outcomes. Welsh Primary Care Outcomes Group.

Increasing attention is being paid to the measurement of outcomes in primary care. However, many of the methods proposed are measures based on readily collectable data or standardized population measures of health status. These may interest population scientists but are unlikely to satisfy most primary-care clinicians. The reason for this dissonance is that the population measures do not reflect the complex and personal nature of primary care. Quality measures are needed that have validity to clinicians and patients. An alternative classification is proposed which is based more formally on the functions of primary care. This would appear to provide a framework which is more likely to be valued by those who provide primary care. The need for further research and testing of some outcome measures is identified.

Clinical Competence↗
PubMed1996

Waiting list management in general practice: a review of orthopaedic patients.

OBJECTIVE: To review all patients on a current general practice orthopaedic waiting list for outpatient appointments with regard to accuracy of the list, clinical priority, and need for further radiological investigation before hospital attendance. DESIGN: Record review by one general practitioner and a radiologist, and discussion with patients of management alternatives. SETTING: Six partner city centre urban fund-holding general practice, list size 8651 (29% low deprivation payment status). SUBJECTS: 116 adults on an orthopaedic waiting list. MAIN OUTCOME MEASURES: List accuracy (patient details and status on waiting list); clinical priority (severity of condition); further investigations (results of tests after radiological review). RESULTS: 32 patients (28%) were removed from the waiting list because of inaccuracies. 14 patients were considered to be high priority and referred to other hospitals by utilising waiting list initiative funds. Of these patients, five agreed to referral to another hospital (treatment completed on average within three months of rereferral), six did not wish to be rereferred, and two did not attend to discuss the offer and remained on the original waiting list. One prioritised patient had further radiological investigations, was reassured, and was taken off the waiting list. 10 patients had further investigations. These resulted in six patients being referred to other hospitals, three being taken off the waiting list, and one seeking private care. CONCLUSIONS: Systematic review of patients on an orthopaedic waiting list of one general practice, though time consuming, led to the identification of inaccuracies in the list and changes in management. Costs need further evaluation, but if the findings occur widely substantial benefits could be achieved for patients.

Adult↗
PubMed1996

A comparison of methods for measuring patient satisfaction with consultations in primary care.

BACKGROUND: Attention needs to be paid to comparing and standardizing methods for measuring patient satisfaction with consultations in primary care. OBJECTIVES: To compare the Medical Interview Satisfaction Scale (MISS) and the Consultation Satisfaction Questionnaire (CSQ) in terms of acceptability, distribution of responses, reliability and gather evidence of validity. In addition, to compare the scores of patients completing the questionnaires immediately after the consultation in the general practitioners' surgeries with those completing the questionnaires later at home. METHODS: The two questionnaires were bound as a single instrument with order determined at random. This was given to patients immediately after their consultations in eight practices in South Glamorgan. RESULTS: One hundred and ninety-eight of 316 (63%) patients completed and returned questionnaires. The distributions of patient satisfaction scores for the two questionnaires were very similar. For the MISS: mean 76.6% (SD 11.4); for the CSQ mean 7.2% (SD 12.6). Correlations between sub-scales ranged from 0.58-0.84 for the MISS and from 0.40-0.79 for the CSQ. The correlation between the overall scales was 0.82. Levels of reliability for the scales and sub-scales were fair to good ranging from 0.78-0.96 for the MISS and from 0.73-0.94 for the CSQ. CONCLUSIONS: The study does not identify one scale as being superior in psychometric terms, however by demonstrating consistency of responses it provides support for the scales as measures of patient satisfaction for use in primary care. The level of inter-correlation suggests that the sub-scales may not be clearly independent of each other and suggests that total scores may be preferred. Lower levels of satisfaction are expressed if patients complete questionnaires at home rather than in general practitioners' surgeries.

Adolescent↗
PubMed1995

The assessment of communication skills in palliative medicine: a comparison of the scores of examiners and simulated patients.

The Diploma in Palliative Medicine was established in 1991 and included communication skills as a major part of the curriculum. In order to assess the efficacy of doctors' communication skills in the Diploma examination, an assessment tool was developed based on the modified Prevara Score. Simulated (actor) patients are used for the consultation in the examination; the doctors' performance is assessed independently by the examiner and by the actor. This provides an opportunity to consider the methods used for describing agreement between raters. There was high correlation between examiners' and actors' scores and high acceptability of the scoring method. However, satisfactory agreement in terms of the mean differences between scores and their standard deviation between examiners' and actors' scores was not achieved. We have found the simulated patient interview to be a useful teaching and assessment tool. The good correlation between the observer's (examiner) and the recipient's (actor-patient) perception of the doctor's interviewing skills provides evidence of the validity of the assessment. However the actor-patients' ratings tended to be higher and the two groups of assessors could not be used interchangeably. We conclude that actor-patients are of value in teaching and in assessing the communication skills of doctors but produce different scores to clinical examiners.

Clinical Competence↗
PubMed1994

Measuring functional health status in primary care using the COOP-WONCA charts: acceptability, range of scores, construct validity, reliability and sensitivity to change.

BACKGROUND: The COOP-WONCA charts comprise six scales designed to measure functional health status in primary care. AIM: A study was undertaken to describe the acceptability, distribution of chart scores, construct validity, test-retest reliability and sensitivity to change when these charts were used in the United Kingdom. METHOD: For acceptability, distribution of scores and construct validity, data were obtained from 100 consecutive consulting patients aged 16 years and over and 100 non-consulting age-sex matched individuals from one general practice. In order to examine reliability and sensitivity to change, both groups were followed up two weeks later. RESULTS: Regarding acceptability, four patients refused to complete the charts during the initial recruitment of the consulters; 74 out of 100 non-consulters returned the first postal questionnaire. The follow-up questionnaire was returned by 68 out of 100 consulters and 57 out of 74 non-consulters. Overall distributions of scores demonstrated reasonable variation. Regarding construct validity, differences between the consulters and non-consulters were all in the anticipated direction and reached statistical significance for three of the six charts. For reliability, the proportion of non-consulters whose scores were unchanged ranged from 56% to 73%. For those whose scores changed, the differences were small and evenly balanced. For sensitivity to change, the proportion of consulters whose scores altered ranged from 45% to 59% with mean changes all indicating improvements in health. There were larger changes for patients consulting about acute problems than for those with chronic problems. CONCLUSION: It appears that the charts were acceptable, with reasonable distributions of scores and evidence of construct validity. Moderate levels of reliability and sensitivity to change were demonstrated. This study suggests that the COOP-WONCA charts are suitable for measuring functional health status in primary care in the UK.

Adolescent↗
PubMed1993

Potential of using simulated patients to study the performance of general practitioners.

A review of the literature on the use of simulated patients is presented. While simulated patients have become established for the education of medical undergraduates, international work suggests that they may also be of value for studying the performance of established general practitioners. A preliminary study is described in which simulated patients were used at practices in Cardiff. Roles were developed which would stimulate a discussion focusing on health risks. No particular practical problems were encountered but concerns were expressed about the validity of the data. Suggestions are made for the further development of the use of simulated patients.

Clinical Competence↗