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Biomedical subjects

Sally Wyke

Publications and source records attributed to Sally Wyke.

18 recordsLinked to original sources
PubMed2006

Symptom experience and subsequent mortality: results from the West of Scotland Twenty-07 study.

BACKGROUND: Associations between symptom experience and mortality have rarely been investigated. One study has suggested that the number of symptoms people experience may be an important predictor of mortality. This novel and potentially important finding may have important implications but needs to be tested in other cohorts. METHODS: 858 people aged around 58 years were interviewed by nurses in 1990/1 as part of the West of Scotland Twenty-07 Study. They were asked about the presence of symptoms in the last month from a checklist of 33 symptoms. Measures of morbidity included symptom type (respiratory, musculoskeletal, gastrointestinal, mental health, neurological, systemic) and symptom summary measures looking at the number and impact of symptoms (total number; number participants tended to have; number participants did not tend to have; number which restricted usual activities; number which led to GP consultation). Hazard ratios for thirteen-year all-cause mortality were calculated for symptom types, symptom summary measures, and self-assessed health with and without adjustment. RESULTS: On unadjusted analysis, and after adjusting for gender, socio-economic status and smoking, mortality was elevated in individuals reporting respiratory, systemic and mental health symptoms. After additional adjustment for chronic conditions and self-assessed health, only the association between mental health symptoms and mortality remained significant. On unadjusted analysis, and after adjusting for gender, socio-economic status and smoking, mortality was elevated in individuals with many (> or = 6) symptoms in four of the symptom summary measures examined. These relationships were no longer significant after additional adjustment for chronic conditions and self-assessed health. A clear trend of increasing mortality as self-assessed health became poorer was observed. This pattern remained statistically significant after adjustment for gender, socio-economic status, smoking, chronic conditions and the total number of symptoms experienced. CONCLUSION: Symptoms often thought of as minor may have important consequences later in life especially for those reporting mental health-related symptoms or those experiencing many symptoms. In this study however, self-assessed health appeared to be a better predictor of mortality than the type or number of symptoms experienced, even when the tendency to have and impact of the symptoms were taken into account.

Attitude to Health↗
PubMed2006

Personal continuity and access in UK general practice: a qualitative study of general practitioners' and patients' perceptions of when and how they matter.

BACKGROUND: Personal continuity is a core value for family practice, but policy and performance targets emphasise other aspects of care, particularly waiting times for consultation. This study examined patient and general practitioner (GP) perceptions of the value of personal continuity and rapid access, and the relationship between them. METHODS: Qualitative analysis of semi-structured interviews with a purposive sample of 16 GPs and 32 patients in the Lothian region of Scotland, to identify whether, how, why and in which circumstances personal continuity and rapid access were valued. RESULTS: From the patients' perspective, what mattered was 'access to appropriate care' depending on the problem to be dealt with. For a few patients, rapid access was the only priority. For most, rapid access was balanced against greater involvement in the consultation when seeing 'their' trusted doctor, which was particularly valued for chronic, complex and emotional problems. GPs focused on the value of personal continuity in the consultation for improving the diagnosis and management of the same kinds of problem. GPs did not perceive enabling access to be a core part of their work. There was little evidence that GPs routinely discussed with patients when or how personal continuity and access should be balanced. CONCLUSION: 'Access to appropriate care' from the patients' perspective is not fully addressed by GPs' focus on personal continuity, nor by performance targets focused only on speed of access. GPs need to make enabling access as much a part of their core values as personal continuity, and access targets need to be based on less simplistic measures that account for the appropriateness of care as well as speed of access.

Adult↗
PubMed2006

Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness.

BACKGROUND: Patient education self-management programmes draw on sociological understanding of experiencing single chronic illnesses, but health practitioners do not always recognize the tensions and ambiguities permeating individuals' management experiences, particularly for those with multiple morbidity. The aim of this study was to illuminate how people negotiate multiple chronic illness, and everyday life. METHODS: A sample of 23 people in their early 50s was recruited from a community health survey in Scotland. The participants had four or more chronic illnesses and were interviewed twice. The qualitative data that were generated highlighted the impact of illness and associated management strategies, as people attempted to continue familiar lives. Analysis was based on constant comparison and informed by a narrative approach. RESULTS: People used multiple techniques to manage symptoms and conveyed a moral obligation to manage 'well'. However, maintaining valued social roles, coherent identities and a 'normal life' were prioritized, sometimes over symptom containment. This led to tensions, and participants faced moral dilemmas as they self-managed. DISCUSSION: Self-management policies, programmes and healthcare practitioners need to recognize the tensions that people experience as they negotiate symptoms, valued social roles, positive identities, and daily life. Addressing these issues may improve opportunities to support patients in particular contexts, and enhance self-management.

Adaptation, Psychological↗
PubMed2005

A managed clinical network for cardiac services: set-up, operation and impact on patient care.

PURPOSE: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. METHODS: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. RESULTS: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference in resource use. DISCUSSION AND CONCLUSIONS: The Managed Clinical Network made a difference to ways of working, particularly in breaching traditional boundaries and involving the public, and made modest changes in patient care. However, it required a two-year "set-up" period. Managed clinical networks are complex initiatives with an increasing profile in health care policy. This study suggests that they require energetic leadership and improvements are likely to be slow and incremental.

Journal Article↗
PubMed2005

"Not that sort of practice": the views and behaviour of primary care practitioners in a study of advance provision of emergency contraception.

BACKGROUND: Advance supplies of emergency contraception (EC) were made available to women aged 16-29 through general practice and family planning services in Lothian, Scotland. Although this intervention was not associated with an overall reduction in abortion rates in Lothian, it was hypothesized that some general practices may have been more successful than others in promoting and delivering the intervention. OBJECTIVE: To investigate, using comparative case studies, whether, and why, some general practices were more successful in promoting and delivering advance supplies of EC than others. METHODS: Eleven purposively sampled general practices from the 97 participating in the intervention were studied. The number of packs of advance supplies distributed was recorded and distribution rates per 100 eligible women per practice calculated. 44 semi-structured interviews with staff were used to describe the mechanisms through which advance supplies were distributed and health professionals' views of the intervention. RESULTS: Distribution rates varied from 0.9 to 32.0 per 100 eligible women. Respondents described three mechanisms through which advance supplies were distributed: passive, reactive and proactive. Views about EC, and the suitability of their patient population for advance supplies, varied and configured specific practice contexts that facilitated or hindered the delivery of advance supplies. Favourable views and pro-active mechanisms were associated with higher distribution rates, less favourable or ambivalent views and passive delivery mechanisms with lower distribution rates. CONCLUSION: If primary care professionals are to actively engage with a sexual health promotion agenda they need to develop appropriate interpersonal skills and address their values, attitudes and cultural competences.

Adolescent↗
PubMed2005

A Scottish postal survey suggested that the prevailing clinical preoccupation with heavy periods does not reflect the epidemiology of reported symptoms and problems.

OBJECTIVE: To determine the prevalence of self-reported menstrual symptoms and problem periods and explore their relationship with sociodemographic factors, parity, long-standing illness, and hormonal contraceptive use. STUDY DESIGN AND SETTING: Postal questionnaire survey of 4,610 women aged 25-44 registered with 19 general practices in Lothian, Scotland. RESULTS: Among menstruating women, 30% reported heavy periods, a further 5% very heavy periods and 15% severe period pain. Although 39% of women reported either heaviness or pain or both, only 22% reported their periods as a marked or severe problem. Multivariate logistic regression showed that reporting problem periods was associated with long-standing illness, heaviness of bleeding, menstrual pain and inversely associated with hormonal contraceptive use. Reporting problem periods was strongly associated with severe pain (OR = 21, 95% CI = 15-28) and with very heavy loss (OR = 14, 95% CI = 8.0-24). CONCLUSIONS: Reporting heavy or painful periods was common but reporting problem periods was less so. Reporting severe pain was at least as strongly associated with problem periods as very heavy periods and severe pain affected many more women than very heavy periods. Therefore the clinical preoccupation with heavy periods does not reflect the epidemiology of menstrual symptoms or problem.

Adult↗
PubMed2005

What happened when Scottish women were given advance supplies of emergency contraception? A survey and qualitative study of women's views and experiences.

The Lothian Emergency Contraception Project in Scotland was a radical intervention in which women aged 16-29 were given 5 packs of emergency contraception (EC) to keep at home. We use survey and qualitative interview data to describe how women used the project packs and their views of advance supplies. The women's accounts suggest that concerns that eased access to emergency contraception will lead to repeated use and risky sex appear to be largely unfounded. Women were pleased to be offered the packs, which were reported as having practical advantages and also sparing them the difficulty of negotiating a sometimes awkward consultation. Respondents explained how they used their packs of EC and in their accounts used justifications, repetition and distancing to emphasise that they would not take risks with contraception or sexually transmitted infections. We interpret the data in the light of the observation that EC has an anomalous role in contraception and the work of applied linguists Candlin and Lucas who have demonstrated the difficulties inherent in the family planning consultation.

Adolescent↗
PubMed2004

Advanced provision of emergency contraception does not reduce abortion rates.

A number of small studies have demonstrated increased use of emergency contraception (EC) when women have a supply available at home. It has been suggested that widespread use of EC could reduce abortion rates. We undertook a community intervention study designed to determine whether offering advanced supplies of EC to large numbers of women influenced abortion rates. All women aged between 16 and 29 years living in Lothian, Scotland, were offered, through health services, five courses of EC without cost to keep at home. Of a population of around 85,000 women in this age group, the study showed that an estimated 17,800 women took a supply of EC home and over 4500 of them gave at least one course to a friend. It was found that nearly half (45%) of women who had a supply used at least one course during the 28 months that the study lasted. In total, an estimated 8081 courses of EC were used. EC was used within 24 h after intercourse on 75% of occasions. Abortion rates in Lothian were compared with those from three other health board areas of Scotland. No effect on abortion rates was demonstrated with advanced provision of EC. The results of this study suggest that widespread distribution of advanced supplies of EC through health services may not be an effective way to reduce the incidence of unintended pregnancy in the UK.

Abortion, Induced↗
PubMed2004

Emergency contraception: why can't you give it away? Qualitative findings from an evaluation of advance provision of emergency contraception.

The Lothian Emergency Contraception Project (LECP)--a primary care-based intervention to offer advance supplies of emergency contraception (EC) to women aged 16-29 was not associated with a reduction in abortion rates. We undertook case studies, utilizing qualitative and quantitative methods, to evaluate the intervention. In this article we present findings from qualitative interviews with 44 primary care professionals working at case study sites and 22 women who had received advance supplies to explain this failure. Professionals reported that women rarely asked for advance supplies of EC and they were reluctant to offer supplies to women because of concerns about contradictory sexual health messages implied by the offer, a perceived association of EC use with chaotic behavior by women, views about the sort of women suitable for advance supplies and practical difficulties making the offer. Women were reluctant to ask for advance supplies because of misgivings about the appropriateness of offering advance supplies to everybody and concerns about being judged by health professionals as morally inadequate. If advance provision of EC is to be successful in reducing abortion rates, professionals must address their concerns about EC and develop imaginative ways of encouraging women most at risk of unwanted pregnancy to take supplies home.

Adolescent↗
PubMed2003

Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use.

OBJECTIVE: To examine attitudes towards drug use among middle aged respondents with high levels of chronic morbidity. DESIGN: Qualitative study with detailed interviews. SETTING: West of Scotland. PARTICIPANTS: 23 men and women aged about 50 years with four or more chronic illnesses. MAIN OUTCOME MEASURE: Participants' feelings about long term use of drugs to manage chronic multiple morbidity. RESULTS: Drugs occupied a central place in the way people managed their comorbidities. Respondents expressed an aversion to taking drugs, despite acknowledging that they depended on drugs to live as "normal" a life as possible. Respondents expressed ambivalence to their drugs in various ways. Firstly, they adopted both regular and more flexible regimens and might adhere to a regular regimen in treating one condition (such as hypertension) while adopting a flexible regimen in relation to others, in response to their experience of symptoms or varying demands of their daily life. Secondly, they expressed reluctance to take drugs, but an inability to be free of them. Thirdly, drugs both facilitated performance of social roles and served as evidence of an inability to perform such roles. CONCLUSIONS: Insight into the considerable tension experienced by people managing complex drug regimens to manage multiple chronic illness may help medical carers to support self care practices among patients and to optimise concordance in their use of prescribed drugs.

Attitude to Health↗
PubMed2003

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

Budgets↗
PubMed2003

Frequent attendance, socioeconomic status and burden of ill health. An investigation in the west of Scotland.

OBJECTIVES: To investigate whether associations between frequent attendance in general practice and socioeconomic circumstances remain significant after taking detailed account of underlying ill health, perceived social support and social isolation. METHODS: Data from a community health survey of 1477 people in their late forties and late sixties living in the West of Scotland were examined for associations between frequent attendance, socioeconomic circumstances, self-reported ill health and social support using logistic regression. The main outcome measure was the probability of being a frequent attender (defined pragmatically after initial review of the distribution as 10+ visits a year) with 95% confidence intervals. RESULTS: Frequent attendance was significantly associated with: greater numbers of serious conditions reported (adjusted odds ratio 1.47; 99% CI 1.09-1.98); higher levels of anxiety (adjusted OR 1.14; 1.04-1.25); and lower levels of self-assessed health (adjusted OR 0.67; 0.54-0.83). No measures of socioeconomic circumstance or social support remained significantly associated with frequent attendance when the greater burden of ill health in poorer and less well-supported groups was considered. CONCLUSION: The higher levels of frequent attendance likely to be experienced by general practitioners serving populations in adverse social circumstances are likely to be explained by higher levels of health needs, and not solely by a greater readiness to consult for whatever reason. General practitioners working in deprived areas are likely to have to 'run to keep up' in dealing with such comorbidity, and ways of supporting them in the provision of optimum healthcare need to be considered.

Adolescent↗
PubMed2003

Women's experiences of Chlamydia screening. Qualitative interviews with women in primary care.

BACKGROUND: Plans are underway to introduce Chlamydia screening in UK primary care. The success of a screening programme depends upon many factors including its acceptability to the population being screened. The experiences of women who have taken part in a pilot study of screening are therefore important in ensuring that services are developed in such a way to maximise health benefits. OBJECTIVES: To explore the experiences of Chlamydia screening among women with both positive and negative results and women who were still waiting for results; to reflect on the implications of their views for primary care based screening programmes. METHODS: Interviews were carried out with twenty women who had participated in a pilot of opportunistic Chlamydia screening carried out in eight general practices in Edinburgh. Four participants had received a positive result, 14 had a negative result and two were still waiting for results. Qualitative analysis was carried out on interview transcripts using the framework approach. RESULTS: Most women saw themselves as at low risk of Chlamydia infection because: it was not perceived as a common infection (many had never heard of it before); they felt that their sexual history did not put them at risk; or because they had no symptoms (although Chlamydia is frequently asymptomatic). Women interviewed welcomed the offer of Chlamydia screening because of the importance of preventing infertility, the ease of testing, and the knowledge that the infection could easily be treated with antibiotics. However, women stressed that it was important to receive adequate information in order to make an informed choice about whether or not to accept the test. CONCLUSIONS: The complexity of messages to be conveyed when offering a Chlamydia screening test, for instance regarding the symptomless nature of the infection and the implications of a positive result, mean that the time taken to communicate this adequately should not be underestimated.

Adolescent↗
PubMed2002

Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices.

BACKGROUND: General practitioners (GPs) in the United Kingdom have recently begun to adopt the use of telephone consultation during daytime surgery as a means of managing demand, particularly requests for same-day appointments. However, it is not known whether the strategy actually reduces GP workload. AIM: To investigate how the use of telephone consultations impacts on the management of requests for same-day appointments, on resource use, indicators of clinical care, and patient perceptions of consultations. DESIGN OF STUDY: Randomised controlled trial. SETTING: All patients (n = 388) seeking same-day appointments in each surgery in two urban practices (total population = 10,420) over a four-week period. METHOD: The primary outcome measure was use of doctor time for the index telephone or face-to-face consultation. Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation, frequency of blood pressure measurement and antibiotic prescriptions, and number of problems considered at consultation. Patient perceptions were measured by the Patient Enablement Instrument (PEI) and reported willingness to use telephone consultations in the future. RESULTS: Telephone consultations took less time (8.2 minutes versus 6.7 minutes; diff = 1.5, 95% confidence interval [CI] = 0.6 to 2.4, P = 0.002). Patients consulting by telephone reconsulted the GP more frequently in the two weeks that followed (0.6 consultations versus 0.4 consultations; diff = 0.2, 95% CI = 0.0 to 0.3, P = 0.01). Blood pressure was measured more often in the group of patients managed face-to-face (25/188 [13.3%] versus 12/181 [6.6%]; diff = 6.7%, 95% CI = 0.6% to 12.7%). There was no significant difference in patient perceptions or other secondary outcomes. CONCLUSION: Use of telephone consultations for same-day appointments was associated with time saving, and did not result in lower PEI scores. Possibly, however, this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion.

Appointments and Schedules↗
PubMed1999

Total purchasing, community and continuing care: lessons for future policy developments in the NHS.

The introduction of total purchasing pilots (TPPs) into the National Health Service (NHS) gave general practitioners (GPs) significant new opportunities to take responsibility for the development of community and continuing care (CCC) services. Based on five case studies of TPPs involved in developing CCC this paper asks three questions: (1) to what extent were the TPP's involvement in CCC informed by an awareness of CCC policy?; (2) were TPPs involved in joint commissioning to develop integrated purchasing or provision which was informed by population based needs assessment?; (3) were TPPs seeking to involve users, carers and voluntary agencies in their plans? The findings indicate that TPPs showed little awareness of national or local policy for CCC, although their project initiatives did address some of the policy issues (in particular a recognition of the need for joint working at the practice level). At the time of fieldwork, four of the case study TPPs had begun to investigate the potential for integrated purchasing, and three of them had relatively sophisticated models of both horizontally and vertically integrated provision of care. However, the TPPs developments were not based on systematic population based needs assessment. The paper concludes that there is potential for the primary care led groups proposed in the recent white papers in England, Scotland and Wales to improve integration of care both horizontally and vertically. However, they may need policy guidance and push to: encourage them to put CCC high on their agenda for action; to work with people with expertise in population based, prevention focused, needs assessment; and to find innovative ways to include users, carers and voluntary agencies. Incentives or levers (such as control over budgets) may be needed to promote joint working between staff in different agencies.

Journal Article↗