Biomedical subjects

R Pill

Publications and source records attributed to R Pill.

At least 19 recordsLinked to original sources

PubMed2004

Public attitudes towards the use of primary care patient record data in medical research without consent: a qualitative study.

OBJECTIVES: Recent legislative changes within the United Kingdom have stimulated professional debate about access to patient data within research. However, there is currently little awareness of public views about such research. The authors sought to explore attitudes of the public, and their lay representatives, towards the use of primary care medical record data for research when patient consent was not being sought. METHODS: 49 members of the public and four non-medical members of local community health councils in South Wales, UK gave their views on the value and acceptability of three current research scenarios, each describing access to data without patient consent. RESULTS: Among focus group participants, awareness of research in primary care was low, and the appropriateness of general practitioners as researchers was questioned. There was general support for research but also concerns expressed about data collection without consent. These included lack of respect and patient control over the process. Unauthorised access to data by external agencies was a common fear. Current data collection practices, including population based disease registers elicited much anxiety. The key informants were equally critical of the scenarios and generally less accepting. CONCLUSIONS: This exploratory study has highlighted a number of areas of public concern when medical records are accessed for research without patient consent. Public acceptability regarding the use of medical records in research cannot simply be assumed. Further work is required to determine how widespread such views are and to inform those advising on confidentiality issues.

Access to Information↗

PubMed2003

Welsh women's comments about breast problems and the care given: a qualitative study in the community.

The aim of this study was to undertake a systematic analysis, using qualitative software, of the free text comments from a postal survey exploring women's experiences of breast symptoms, their expectations of treatment, knowledge of breast cancer risk factors and perceptions of risk, in 34 group general practices in South Wales. The 959 women who returned the questionnaire, out of 1126 (response rate 85%), comprised 497 women who consulted their general practitioner (GP) with a new breast symptom during the baseline data collection period and 462 controls who had not. When the survey was conducted the researchers did not know whether these women had cancer or had previously been treated for it. One-third (33.1%) of those returning the survey (n = 318) wrote comments. Compared to the rest, they were significantly more likely to have consulted their GP for a new breast symptom and to have stayed on at school and/or gone on to more education or training. The majority wrote about their own experience of breast symptoms and/or the care received in primary and secondary settings. The general tone was factual and when evaluation took place positive comments were more frequent than negative ones. Nothing suggested that the respondents had been upset or made more anxious by the preceding questions on such a potentially sensitive topic. Free text comments gathered in surveys can provide valuable data if systematically analysed. Doctors, particularly GPs, can be reassured that more women in this community sample who expressed an opinion on care were positive. The negative comments, however, highlight issues that still need to be addressed in therapeutic relationships.

Adolescent↗

PubMed2001

Lay attitudes to professional consultations for common mental disorder: a sociological perspective.

How, why, and under what kinds of circumstances lay people consult for symptoms of emotional distress are topics that have commanded various degrees of attention from secondary and primary care professionals. We argue below that many of the responses made by such professionals to these issues carry within them a set of very important assumptions about how members of the lay public view psychiatric symptoms. Whether such assumptions are justified by the evidence is, however, a matter of some debate. In what follows we draw on some recent, sociologically informed research on lay attitudes to emotional distress so as to highlight the debates and to suggest some ways in which they might be resolved.

Affective Symptoms↗

PubMed2000

Qualitative study of views of health professionals and patients on guided self management plans for asthma.

OBJECTIVES: To explore the views held by general practitioners, practice nurses, and patients about the role of guided self management plans in asthma care. DESIGN: Qualitative study using nine focus groups that each met on two occasions. SETTING: South Wales. SUBJECTS: 13 asthma nurses, 11 general practitioners (six with an interest in asthma), and 32 patients (13 adults compliant with treatment, 12 non-compliant adults, and seven teenagers). RESULTS: Neither health professionals nor patients were enthusiastic about guided self management plans, and, although for different reasons, almost all participants were ambivalent about their usefulness or relevance. Most professionals opposed their use. Few patients reported sustained use, and most felt that plans were largely irrelevant to them. The attitudes associated with these views reflect the gulf between the professionals' concept of the "responsible asthma patient" and the patients' view. CONCLUSIONS: Attempts to introduce self guided management plans in primary care are unlikely to be successful. A more patient centred, patient negotiated plan is needed for asthma care in the community.

Adolescent↗

PubMed2000

Does experience predict knowledge and behavior with respect to cutaneous melanoma, moles, and sun exposure? Possible outcome measures.

A prospective survey of 3105 adults in 16 randomly selected group practices was conducted to test whether individuals with a personal experience, family history, or other contact with malignant melanoma display more knowledge and appropriate behavior with regard to melanomas and sun exposure than those with no such experience. Although patients with previous contact with the condition were more likely to check for moles, were more aware of the significance of changes in the shape of moles, and were more aware of the necessity for prompt treatment, they were not more knowledgeable about other important signs or more likely to protect themselves from sun exposure. Direct experience or contact with melanoma appeared to have some positive effects on knowledge, but there is no room for complacency for those at increased risk or those treating them. Both primary and secondary prevention for people who are vulnerable could be undertaken in primary care.

Adolescent↗

PubMed2000

Identifying which women will stop breast feeding before three months in primary care: a pragmatic study.

BACKGROUND: In Britain only 42% of women who initiate breast feeding are still breast feeding at four months, despite well documented health benefits. AIM: To explore whether sociodemographic and social support information collected routinely by health visitors at the new birth assessment can help predict which women will give up breast feeding before three months. METHOD: A survey of 279 consecutive births in three general practices in an inner-London borough. Health visitors collected sociodemographic, infant feeding, and social support data at the new birth assessment 10 to 14 days after birth and at an immunisation visit at three to four months after birth. A data collection form was piloted and used by health visitors as part of their routine clinical care. Stepwise logistic regression was performed on 160 women who initiated breast feeding to identify predictors for those who would still be breast feeding at three months. RESULTS: Three variables were found to be significantly associated with breast feeding at three months. Younger women and women with moderate to poor emotional support as assessed by their health visitor were less likely to still be breast feeding at three months. White women who left full-time education at age 16 years or below are least likely to be breast feeding at three months but educational level is not a significant predictor for women from other ethnic backgrounds. CONCLUSION: This pragmatic study illustrates how information collected during routine clinical care by health visitors can help predict which women will give up breast feeding before three months. This could be useful to identify women whose social support needs are not being met and who may benefit from local initiatives. Infant feeding researchers should consider the influence of ethnicity and levels of social support on breast feeding outcomes.

Adolescent↗

PubMed1999

Qualitative study of decisions about infant feeding among women in east end of London.

OBJECTIVE: To improve understanding of how first time mothers who belong to a socioeconomic group with particularly low rates of breast feeding decide whether or not to initiate breast feeding. DESIGN: Qualitative semistructured interviews early in pregnancy and 6-10 weeks after birth. SETTING: Women's homes in east end of London. SUBJECTS: 21 white, low income women expecting their first baby were interviewed mostly at home, often with their partner or a relative. Two focus groups were conducted. RESULTS: Women who had regularly seen a relative or friend successfully breast feed and described this experience positively were more confident about and committed to breast feeding. They were also more likely to succeed. Exposure to breast feeding, however, could be either a positive or a negative influence on the decision to breast feed, depending on the context. Women who had seen breast feeding only by a stranger often described this as a negative influence, particularly if other people were present. All women knew that breast feeding has health benefits. Ownership of this knowledge, however, varied according to the woman's experience of seeing breast feeding. CONCLUSIONS: The decision to initiate breast feeding is influenced more by embodied knowledge gained from seeing breast feeding than by theoretical knowledge about its benefits. Breast feeding involves performing a practical skill, often with others present. The knowledge, confidence, and commitment necessary to breast feed may be more effectively gained through antenatal apprenticeship to a breastfeeding mother than from advice given in consultations or from books.

Adolescent↗

PubMed1999

Efficient literature searching in diffuse topics: lessons from a systematic review of research on communicating risk to patients in primary care.

Using the example of communication about risk in a primary care setting, this paper puts forward a method of developing and evaluating a detailed search strategy for locating the literature for a systematic review of a 'diffuse' subject. The aim of this paper is to show how to develop a search strategy that maximizes both recall and precision while keeping search outputs manageable. Six different databases were used, namely Medline, Embase, PsychLIT, CancerLIT, Cinahl and Social Science Citation Index (SSCI). The searches were augmented by hand-searching, contacting authors, citation searching and reference lists from included papers. Other databases were searched but yielded no extra references for this subject matter. Of the 99 papers included, 80 were indexed on Medline. The Medline search strategy identified 54 of them and the remaining 26 were located on other databases. The 19 further unique references were found using the other databases and methods of retrieval. A combination of several databases must be used to maximize recall and to increase the precision of searches on individual databases, thus improving the overall efficiency of the search.

Databases, Bibliographic↗

PubMed1999

Can nurses learn to let go? issues arising from an intervention designed to improve patients' involvement in their own care.

The aim of the paper was to explore the reasons behind a perplexing observation that an intervention designed to alter professional behaviour in general practice consultations in South Wales was poorly sustained despite initial enthusiasm among the nurses. Nurses' baseline and continuing responses to the new approach with patients with non-insulin dependent diabetes are described, drawing on observations and interviews with the 18 practice nurses in the 15 experimental practices. The nurses fell into two groups: those showing greater understanding of the principles underlying the approach and a more reflective attitude to their work; and those who adapted the simple technology provided to their usual consultation style. This variation was related to their perception of their role and their attitudes to diabetic care, especially the challenge posed by the 'difficult patient'. They were noticeably less willing to allow the patient freedom to decide what to do once diabetic control was deteriorating according to biochemical measures. It is concluded that the failure of the nurses to sustain behaviour change over time stems from a basic dilemma, namely, what is the extent of my responsibility and how ought I to discharge it? There is scope for more research into professional perspectives on chronic care, the strategies they use to manage patients and to cope with their own feelings, and the implications of these strategies for patients.

Attitude of Health Personnel↗

PubMed1999

Moles and melanomas--who's at risk, who knows, and who cares? A strategy to inform those at high risk.

BACKGROUND: Malignant melanoma is uncommon but potentially fatal. Knowledge and attitudes play an important part in the early detection of this skin cancer. AIM: To assess knowledge, risk perception, and intended behaviour related to melanoma compared with actual risk status. To suggest measures to improve the primary and secondary prevention of melanoma in general practice for a high-risk group. METHOD: A prospective questionnaire survey was carried out on consecutive adults attending in 16 randomly selected group practices. Applying MacKie's personal risk factor chart for melanoma, the study assessed self-reported risk, knowledge of skin cancer--especially malignant melanoma--and self-reported preventive activity. RESULTS: A total of 3105 (69%) attenders completed the questionnaire. The responders showed greater concern for minor rather than major clinical signs in pre-existing moles. Young people and the professional classes were the least knowledgeable about skin cancer and exhibited the most risky behaviour in terms of sun exposure, failure to check their skin, and to seek medical advice about new or changing moles. The majority of an 8.7% high-risk group showed lack of awareness of their increased risk, and women in this group reported the highest desire for a suntan and the use of sunbeds. In addition to showing less concern than their low risk counterparts about moles growing in size, they were also reluctant to seek medical advice about new moles. CONCLUSION: Consideration should be given to targeting primary prevention and selective screening in general practice towards a high-risk group for malignant melanoma. Young people and the professional social class should receive particular attention.

Adolescent↗

PubMed1998

Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats.

OBJECTIVES: To better understand reasons for antibiotics being prescribed for sore throats despite well known evidence that they are generally of little help. DESIGN: Qualitative study with semi-structured interviews. SETTING: General practices in South Wales. SUBJECTS: 21 general practitioners and 17 of their patients who had recently consulted for a sore throat or upper respiratory tract infection. MAIN OUTCOME MEASURES: Subjects' experience of management of the illness, patients' expectations, beliefs about antibiotic treatment for sore throats, and ideas for reducing prescribing. RESULTS: Doctors knew of the evidence for marginal effectiveness yet often prescribed for good relationships with patients. Possible patient benefit outweighed theoretical community risk from resistant bacteria. Most doctors found prescribing "against the evidence" uncomfortable and realised this probably increased workload. Explanations of the distinction between virus and bacterium often led to perceived confusion. Clinicians were divided on the value of leaflets and national campaigns, but several favoured patient empowerment for self care by other members of the primary care team. Patient expectations were seldom made explicit, and many were not met. A third of patients had a clear expectation for antibiotics, and mothers were more likely to accept non-antibiotic treatment for their children than for themselves. Satisfaction was not necessarily related to receiving antibiotics, with many seeking reassurance, further information, and pain relief. CONCLUSIONS: This prescribing decision is greatly influenced by considerations of the doctor-patient relationship. Consulting strategies that make patient expectations explicit without damaging relationships might reduce unwanted antibiotics. Repeating evidence for lack of effectiveness is unlikely to change doctors' prescribing, but information about risk to individual patients might. Emphasising positive aspects of non-antibiotic treatment and lack of efficacy in general might be helpful.

Anti-Bacterial Agents↗

PubMed1998

Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion.

OBJECTIVES: To determine the effectiveness and acceptability of general practitioners'opportunistic antismoking interventions by examining detailed accounts of smokers' experiences of these. DESIGN: Qualitative semistructured interview study. SETTING: South Wales. SUBJECTS: 42 participants in the Welsh smoking intervention study were asked about initial smoking, attempts to quit, thoughts about future smoking, past experiences with the health services, and the most appropriate way for health services to help them and other smokers. RESULTS: Main emerging themes were that subjects already made their own evaluations about smoking, did not believe doctors' words could influence their smoking, believed that quitting was down to the individual, and felt that doctors who took the opportunity to talk about smoking should focus on the individual patient. Smokers anticipated that they would be given antismoking advice by doctors when attending for health care; they reacted by shrugging this off, feeling guilty, or becoming annoyed. These reactions affected the help seeking behaviour of some respondents. Smokers were categorised as "contrary," "matter of fact," and "self blaming," depending on their reported reaction to antismoking advice. CONCLUSIONS: Doctor-patient relationships can be damaged if doctors routinely advise all smokers to quit. Where doctors intervene, a patient centred approach-one that considers how individual patients view themselves as smokers and how they are likely to react to different styles of intervention-is the most acceptable.

Adolescent↗

PubMed1998

Recognising meningococcal disease in primary care: qualitative study of how general practitioners process clinical and contextual information.

OBJECTIVES: To describe the presentation of meningococcal disease in primary care; to explore how general practitioners process clinical and contextual information in children with meningococcal disease; and to describe how this information affects management. DESIGN: Qualitative analysis of semistructured interviews. SETTING: General practices in South Glamorgan. SUBJECTS: 26 general practitioners who between January 1994 and December 1996 admitted 31 children (under 16 years of age) in whom meningococcal disease was diagnosed. MAIN OUTCOME MEASURES: Categories of clinical rules and techniques used by general practitioners in processing each case. RESULTS: 22 children had rashes; in 16 of them the rashes were non-blanching. When present, a haemorrhagic rash was the most important factor in the doctor's decision to admit a child. 22 children had clinical features not normally expected in children with acute self limiting illnesses--for example, lethargy, poor eye contact, altered mental states, pallor with a high temperature, and an abnormal cry. Contextual information, such as knowledge of parents' consultation patterns and their normal degree of anxiety, played an important part in the management decisions in 15 cases. Use of penicillin was associated with the certainty of diagnosis and the presence and type of haemorrhagic rash. CONCLUSION: The key clinical feature of meningococcal disease--a haemorrhagic rash--was present in only half of the study children. The general practitioners specifically hunted for the rash in some ill children, but doctors should not be deterred from diagnosing meningococcal disease and starting antibiotic treatment if the child is otherwise well, if the rash has an unusual or scanty distribution, or if the rash is non-haemorrhagic.

Adolescent↗

PubMed1998

Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score.

OBJECTIVES: To establish whether a questionnaire incorporating MacKie's risk factor flow chart can identify patients at high risk for melanoma so that they can be targeted for primary and secondary prevention. To validate the risk score derived from the questionnaire and test the feasibility of self completion by comparing patients' self reported skin characteristics with a skin examination performed by an experienced general practitioner. DESIGN: Prospective questionnaire survey followed by a comparative study. SETTING: 16 randomly selected group practices in a health district in Cheshire, United Kingdom. SUBJECTS: Questionnaire survey--3105 consecutive patients aged 16 years and over attending for a primary care consultation; comparative study--a self selected subsample of 388 of the 3,105 patients. MAIN OUTCOME MEASURES: MacKie risk group for melanoma. Comparison of high risk skin characteristics reported by patients and those noted during a skin examination by a doctor (kappa statistic). RESULTS: 4.3% of patients (87% women) were in the highest risk group and 4.4% (79% men) were in the second highest risk group, as defined by the MacKie score. Agreement between patients' self appraisal of skin characteristics and clinical skin examinations was reflected in kappa values of 0.67 for freckles, 0.60 for moles, and 0.43 for atypical naevi. CONCLUSION: This questionnaire helped to identify a group at high risk for melanoma. Furthermore, good agreement was found when the patient's risk scores were compared with results of the clinical skin examination. This risk score is potentially useful in targeting primary and secondary prevention of melanoma through general practice.

Age Distribution↗

PubMed1998

A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour.

AIM: Our objective was to evaluate the effect of training in a patient-centred intervention for GPs and practice nurses on outcomes for patients with Type II diabetes. METHODS: We carried out a randomized controlled trial within general practices as the basis for randomization and a before-and-after design for measures of patient outcome. A parallel process study examined the use of the method by professionals. The study was carried out in 29 general practices in South Glamorgan who had participated for at least 2 years in a local scheme of audit and CME in relation to Type II diabetes care. The subjects were 252 Type II diabetic patients recruited by 15 experimental and 14 control practices. The main outcome measures were changes in glycosylated haemoglobin, patient satisfaction with care and treatment, functional health status and professional ability to apply the intervention. RESULTS: Professionals adopted the innovative method with enthusiasm, but after 2 years only 19% continued to apply the method systematically. The trial was, therefore, unable to demonstrate significant biochemical or functional improvements. This highlights the need to understand the factors associated with professional uptake and subsequent ability to sustain changes in behaviour. CONCLUSIONS: The efficacy of this behavioural intervention remains unproved, despite its acceptability to professional staff. Detailed and prolonged development and testing of behavioural interventions is an essential first step before embarking on randomized controlled trials which involve complex behavioural changes in professionals or patients.

Adult↗

PubMed1998

Communication about risk: diversity among primary care professionals.

OBJECTIVE: We aimed to identify the important clinical topics and to report current practice of communication about risk in primary care. METHODS: We carried out a qualitative study using six semi-structured focus group discussions with primary care professionals. The subjects were 36 primary care professionals from general practice, practice nurse, district nurse, community psychiatric nurse and health visitor disciplines. RESULTS: All clinical topics were felt to raise issues of effective risk communication. Participants expressed concern about the lack of accessible up-to-date information and the problems of conveying information to patients. They described the circumstances and contexts in which communication varies and is difficult, and identified media and medico-legal influences and professional uncertainty as also contributing to the problems of risk communication. Specific training in risk communication was identified as an important need. CONCLUSIONS: The complexity of risk communication and diversity of influences on it will require wide-ranging interventions in order to address them. Standardized communication may be a difficult goal to attain.

Communication↗

PubMed1998

Communication about risk: the responses of primary care professionals to standardizing the 'language of risk' and communication tools.

OBJECTIVE: We aimed to gauge responses of primary care professionals to standardization of the 'language of risk' and risk communication tools. METHODS: We carried out a qualitative study using six semi-structured focus group discussions. The subjects were 36 primary care professionals from general practice, practice nurse, district nurse, community psychiatric nurse and health visitor disciplines. RESULTS: Between professionals, the standardization of the language of risk was felt to have potential benefit in making professionals consistent in their appreciation of risks and communication with each other. Between professionals and patients, standardized language was thought inappropriate or insufficient because of contextual variation in communication and interpretation of risk information by patients. The use of more-detailed comparisons of risks was felt to be a potentially effective development of risk communication in practice. CONCLUSIONS: A standard language of risk communication was perceived as being potentially helpful for communication between professionals, but many respondents were sceptical about its usefulness in communication with patients.

Communication↗

PubMed1997

Medication, chronic illness and identity: the perspective of people with asthma.

The issue of compliance with prescribed medication has traditionally been dominated by the perspective of the health professional although increasingly sociologists, using qualitative methods, have begun to present the patients' point of view. However, little has been published on asthma, despite the numbers of people suffering from this chronic condition and the amount of medication regularly prescribed. This paper focuses on the perspective of a sample of S. Wales (U.K.) asthma patients who have all been prescribed prophylactic medication in the last 12 months and explores their attitudes to medication in the context of their everyday lives, using inductive qualitative research methods. Two main groups were identified: the deniers and the accepters. They differed fundamentally in their readiness to accept the identity of asthma sufferer which, in turn, was associated with very different beliefs about the nature of their problem and the meaning of the medication prescribed for it. There was also marked differences in their strategies of self-presentation and disclosure and their pattern of medication use, particularly for prophylactic medication. A third group, the pragmatists, were also identified as a possible sub-group of the accepter category who are less open within self-presentation and less consistent in their beliefs about asthma but do not reject the label entirely. Identity work, i.e. the way the respondents interpreted the social identity of asthma sufferers and managed to reconcile it with other social identities, is proposed as the most useful way of understanding the observed variation in the way people diagnosed as asthmatic conceptualise and use their medication.

Adolescent↗