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Biomedical subjects

S Iliffe

Publications and source records attributed to S Iliffe.

At least 37 records · Page 2Linked to original sources
PubMed2000

Assessing needs from patient, carer and professional perspectives: the Camberwell Assessment of need for Elderly people in primary care.

BACKGROUND: despite evidence that needs assessment of older people can improve survival and function when linked to effective long-term management, there is no structured needs assessment tool in widespread use. The Camberwell Assessment of Need for the Elderly is a new tool not previously evaluated in primary care. It includes the views of patients, carers and health professionals, enabling a direct comparison of their perspectives. AIM: to conduct a feasibility study of Camberwell Assessment of Need for the Elderly in primary care and to compare the needs identified by patients, carers and health professionals. METHODS: we selected a random sample of 1:20 of all people aged 75 and over from four general practices in inner-city and suburban north-west London. We interviewed the patients, their informal carers and lead health professionals using the Camberwell Assessment of Need for the Elderly schedule. RESULTS: 55 (65.5%) of 84 patients, 15 (88.2%) of 17 carers and all of 55 health professionals completed interviews. The patients' three most frequently identified unmet needs were with 'eyesight/hearing', 'psychological distress' and 'incontinence'. The carers' three most frequently identified unmet needs were with 'mobility', 'eyesight/hearing' and 'accommodation' and the health professionals' were with 'daytime activities', 'accommodation' and 'mobility'. Kappa tests comparing patient and health professional assessments showed poor or fair agreement with 18 of the 24 variables and moderate or good agreement with six. None showed very good agreement. CONCLUSION: the Camberwell Assessment of Need for the Elderly schedule is feasible to use in primary care and can identify perceived needs not previously known about by health professionals. A shorter version of Camberwell Assessment of Need for the Elderly focusing on areas of poor agreement and high levels of need might be useful in the assessment of needs in older people in primary care.

Aged↗
PubMed2000

New labour and Britain's National Health Service: an overview of current reforms.

Britain's National Health Service (NHS) has been the subject of unprecedented market reforms, which have failed to solve its problems. The New Labour government elected in 1997 has halted the drive toward the marketization of health care and replaced cost with quality as the central concern of NHS administration and policy. Major changes are occurring in the regulation of professional activity, with profound implications for the medical profession and the health service. The authors discuss these changes and possible future problems for the NHS.

Economic Competition↗
PubMed1999

Promoting physical activity in general practice: should prescribed exercise be free?

In the UK there are numerous schemes whereby general practitioners can prescribe exercise programmes, usually based in leisure centres. Of the factors that discourage adherence to such programmes in the USA, cost has proved important. We collected demographic and questionnaire data from 152 inner-London patients (108 women, 44 men) before they started an exercise programme on a National Health Service prescription, and analysed the results according to whether they dropped out of the programme (78%) or not. Use of logistic regression revealed only one previous barrier to exercise, 'not knowing about local exercise facilities', as a significant positive determinant of adherence (adjusted odds ratio 3.51, 95% confidence interval, 1.04 to 11.86). For 'lack of money' patients were more likely to drop out of the programme (adjusted odds ratio 0.25, 95% CI 0.07-0.85). The very low cost of participation in this scheme, did not encourage adherence, particularly by those who had cited 'lack of money' as a previous barrier. The case of making prescribed exercise free or even low-cost remains unproven.

Adolescent↗
PubMed1998

Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomised controlled trials.

OBJECTIVE: To assess whether population screening for impaired vision among older people in the community leads to improvements in vision. DESIGN: Systematic review of randomised controlled trials of population screening in the community that included any assessment of vision or visual function with at least 6 months' follow up. SUBJECTS: Adults aged 65 or over. MAIN OUTCOME MEASURE: Proportions with visual impairment in intervention and control groups with any method of assessing visual impairment. RESULTS: There were no trials that primarily assessed visual screening. Outcome data on vision were available for 3494 people in five trials of multiphasic assessment. All the trials used self reported measures for vision impairment, both as screening tools and as outcome measures. The inclusion of a visual screening component in the assessment did not result in improvements in self reported visual problems (pooled odds ratio 1.04:95% confidence interval 0.89 to 1.22). A small reduction (11%) in the number of older people with self reported visual problems cannot be excluded. CONCLUSIONS: Screening of asymptomatic older people in the community is not justified on present evidence. Visual impairment in this age group can usually be reduced with treatment. It is unclear why no benefit was seen. Further work is needed to clarify what interventions are appropriate for older people with unreported impairment of vision.

Aged↗
PubMed1998

The effectiveness of hospital at home compared with in-patient hospital care: a systematic review.

BACKGROUND: Despite the widespread adoption of hospital at home services it is not known if these services represent an effective way to manage patients, compared with in-patient hospital care. METHOD: A systematic review was carried out of randomized controlled trials comparing hospital at home care with acute hospital in-patient care for patients age 18 years and over, excluding those with long-term care needs, obstetric patients, and those requiring mental health services. The following databases were searched: Medline, Embase, Social Science Citation Index, CINAHL, EconLit, PsychLit, SIGLE, Medical Care supplement on economic literature, and the EPOC (Cochrane Effective Practice and Organization of Care Review Group) register. Data were extracted for the following outcomes: mortality, clinical complications, re-admissions, costs, hospital days saved from the provision of hospital at home, discharge destination from hospital at home, functional status, psychological well-being, patient satisfaction and carer satisfaction. Data analysis and quality assessment were undertaken independently by two reviewers using a data checklist, following standard methods described by the EPOC group. RESULTS: Five trials were included in the review. No statistically significant differences were detected for patient health outcomes. Patients discharged early from hospital to hospital at home following elective surgery expressed greater satisfaction with care than those who remained in hospital. Carers, however, expressed less satisfaction with hospital at home compared with hospital care. Only one trial, which recruited patients requiring terminal care, formally tested for a difference in cost. No statistically significant difference was detected for overall net health costs. CONCLUSIONS: This review does not support the widespread adoption of hospital at home, nor the discontinuation of existing schemes for elderly medical patients, patients who have had elective surgery, or those with a terminal illness. There is insufficient evidence to determine the effect of hospital at home on patient outcomes, or cost to the health service.

Home Care Services, Hospital-Based↗
PubMed1998

The London Academic Training Scheme: learning research methods through teaching.

BACKGROUND: The London Academic Training Scheme (LATS) provides a 1-year training programme in research methods and teaching for GPs who have recently finished vocational training. This paper describes an adult educational approach to learning about research methods through teaching as part of the LATS trainees' weekly academic programme. OBJECTIVE: We aimed to provide and evaluate a course exploring research methodologies used in primary care by a three-step approach to learning, with trainees taking the main role as teachers. METHOD: Trainees on the LATS programme met for one afternoon each week for one term. During alternate sessions a pair of trainees would deliver a whole afternoon's seminar on one aspect of primary care research methodology. The teaching of each session was evaluated by the whole group, by academic supervisors and by experts. RESULTS: Sessions were scored by participants for content, style of presentation, educational value and enjoyment on a seven-point rating scale where 1 = no value, 4 = neutral and 7 = very valuable. All sessions scored above 4 and usually above 5 for each aspect. Open comments collected showed that trainees greatly appreciated this self-directed approach to learning and teaching. CONCLUSION: The active involvement of learners as teachers is a practical and rewarding means of using adult educational principles in providing an academic programme.

Curriculum↗
PubMed1997

The 'research magnificent' in late life: psychiatric epidemiology and the primary health care of older adults.

OBJECTIVE: Primary care occupies a strategic positive in the evaluation, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairment. METHOD: The literature was selectively reviewed for each theme to ask the central question, "What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?" RESULTS: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the "middle ground of psychiatric epidemiology"--primary health care--have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the mental disturbances of late life, and how these intersect with other salient factors. CONCLUSIONS: Primary care physicians and others who work in primary care should advocate for further mental health integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.

Adult↗
PubMed1997

Promoting healthy exercise among older people in general practice: issues in designing and evaluating therapeutic interventions.

The potential health benefits derived from sustained physical activity in older people are numerous; however, whether exercise promotion should take place in general practice is unsubstantiated. Exercise promotion should use existing research evidence of the advantages of exercise for various conditions, and target those inactive individuals who currently have no intention of changing their level of physical activity. Research has also raised methodological issues and questions about the feasibility of exercise interventions which still need to be tested in exercise trials conducted in general practice.

Aged↗
PubMed1996

Hospital at home.

Explore the source record for details and available documents.

Community Health Services↗
PubMed1996

A prototype computer decision support system for the management of asthma.

Asthma is a chronic disease estimated to affect 6-7% of the total UK population. In addition, a number of studies have shown that asthma has become commoner since the 1970s, especially in children. The diagnosis of asthma can be difficult and its management requires the involvement of patients in a long-term treatment plan, something which general practitioners may be unable to achieve easily in the average 10-min consultation. As a consequence, asthma is underdiagnosed and undertreated. Deaths from the disease are often avoidable with timely and sufficient use of the available medication. In order to support this, the British Thoracic Society (BTS) has published guidelines for asthma management based upon a stepwise approach, in which a patient is categorized as being on one of five steps according to the severity of his or her asthma. The guidelines give "rules of thumb" for deciding when the patient should move up or down the steps. The most recent version of the guidelines also included special rules for children. Within a recent European Community project on Advanced Informatics in Medicine (AIM), we developed a prototype decision support system for asthma management targeted at the primary care setting and based on the British Thoracic Society guidelines. This paper reports this development, and describes the further work needed on the prototype. Plans for evaluation of the knowledge bases and for future full application production are also described.

Artificial Intelligence↗
PubMed1996

The modernisation of general practice in the UK: 1980 to 1995 and beyond. Part I.

The UK is unusual in providing universal free healthcare in which access to specialists is largely controlled by general practitioners with 24-hour responsibility, throughout the year, for a defined list of patients of all ages. It is generally considered that this gatekeeper function has contributed to the relatively low cost of the National Health Service, but major changes in the organisation and clinical role of general practitioners have occurred, culminating in a new contract that aims to re-orientate general practice towards health promotion, disease prevention and the management of chronic disease. The implications of these changes are discussed.

Community Health Nursing↗