Biomedical subjects

Vicky Hammersley

Publications and source records attributed to Vicky Hammersley.

6 recordsLinked to original sources

PubMed2006

Sex inequalities in access to care for patients with diabetes in primary care: questionnaire survey.

BACKGROUND: Health experiences differ between men and women. The health services have focused their attention on gynaecological health problems in women, however women with non-gynaecological health problems could be unintentionally neglected. Given the increased prevalence of diabetes, the healthcare needs and experiences of women with diabetes are increasing. AIM: To determine the extent of sex inequalities in access to care for diabetes in primary care. DESIGN OF STUDY: Cross-sectional population-based questionnaire study. SETTING: Twenty-three general practices spread through 23 different primary care trusts in the former Trent Region, UK. METHOD: The study consisted of a random sample of 1,673 patients with diabetes. Outcomes measured were odds ratios adjusted for age for measures of physical access to the GP's surgery; ease of obtaining appointments; access to primary care professionals; levels of routine diabetes care received; barriers to physical activity, problems eating and psychological distress as measured by the 18 score Diabetes Health Profile. RESULTS: Women were less likely than men to report that they had talked to their GP or practice nurse about their diabetes in the previous 12 months and were less likely to report that they were able to book routine appointments at convenient times. Almost 40% of all patients with diabetes reported difficulty in visiting the GP's surgery for their diabetes care, and women were more likely to report difficulties in visiting the surgery than men. Women were more likely than men to be afraid to go out alone (7.9% versus 3.6%) and more likely to be housebound (6.8% versus 2.4%). Women had significantly higher scores for eating problems and barriers to physical activity than men. CONCLUSIONS: Women report more problems with access to diabetes care than men. If the ambitions of the National Service Framework are to be met, then positive action needs to be taken to improve access to care for women with diabetes.

Aged↗

PubMed2005

Does increased use of private health care reduce the demand for NHS care? A prospective survey of general practice referrals.

BACKGROUND: The use of the private sector for health care is increasing, but it is unclear whether this will reduce demand on the NHS. The aim of this study was to examine the relationship between private and NHS outpatient referral rates accounting for their association with deprivation. METHODS: This is a prospective survey of general practitioner referrals to private and NHS consultant-led services between 1 January and 31 December 2001 from 10 general practices in the Trent Focus Collaborative Research Network, United Kingdom. Patient referrals were aggregated to give private and NHS referral rates for each electoral ward in each practice. RESULTS: Of 17,137 referrals, 90.4 percent (15,495) were to the NHS and 9.6 percent (1642) to the private sector. Private referral rates were lower in patients from the most deprived fifth of wards compared with the least deprived fifth (rate ratio 0.25, 95 percent CI 0.15 to 0.41, p < 0.001), whereas NHS referral rates were slightly higher in patients in the most deprived fifth of wards (rate ratio 1.18, 95 percent CI 0.98 to 1.42, p = 0.08) both after age standardisation and adjustment for practice. The NHS referral rate was significantly higher (rate ratio 1.40, 95 percent CI 1.15 to 1.71, p = 0.001) in wards with private referral rates in the top fifth compared with the bottom fifth after adjustment for deprivation and practice. CONCLUSIONS: Increased private health care activity does not reduce the demand for NHS care: NHS and private referral rates were positively associated with each other after adjusting for age, deprivation and practice.

Adolescent↗

PubMed2003

The electronic patient record in primary care--regression or progression? A cross sectional study.

OBJECTIVES: To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve. DESIGN: Cross sectional study with review of medical records and interviews with general practitioners. SETTING: 25 general practices in Trent region. PARTICIPANTS: 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations. MAIN OUTCOME MEASURES: Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made. RESULTS: Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03). CONCLUSION: We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records.

Adult↗

PubMed2003

Explaining variations in reported diabetes prevalence in general practice: how much variation is explained by differences between practice populations?

There are large variations in reported diabetes prevalence within United Kingdom (UK) populations. Linear regression was used to investigate whether population characteristics could explain the variation in prevalence between 19 practices with relatively complete diagnostic recording. Population obesity and South Asian ethnicity largely explained observed variation in prevalence (adjusted R2 = 0.80). When adjusted for obesity and ethnicity, the deprivation score was no longer a predictor of diabetes prevalence. If true variation in prevalence between practices is largely predicted by population ethnicity and obesity, these population characteristics could be used to predict expected prevalence and to assess the completeness of practice registers.

Aged↗

PubMed2002

Married couples' risk of same disease: cross sectional study.

OBJECTIVE: To determine whether people whose marital partners have depression, diabetes, hypertension, ischaemic heart disease, stroke, hyperlipidaemia, peptic ulcer disease, or asthma or chronic obstructive pulmonary disease are at increased risk of the same disease. DESIGN: Cross sectional study. SETTING: 10 practices from the Trent Focus Collaborative Research Practice Network. PARTICIPANTS: 8386 married couples (16 772 individuals) from a population of 29 014 participants aged 30-74 years. OUTCOMES: Risk of disease in participants whose marital partner had that disease compared with those whose partner did not. RESULTS: After both partners' age, smoking, and obesity and which general practice they attend were adjusted for, participants whose marital partner had asthma, depression, hypertension, hyperlipidaemia, and peptic ulcer disease were at increased risk of having the same disease. The adjusted odds ratios were 1.69 (95% confidence interval 1.43 to 2.98) for asthma, 2.08 (1.71 to 2.54) for depression, 1.32 (1.04 to 1.67) for hypertension, 1.44 (1.19 to 1.75) for hyperlipidaemia, and 2.01 (1.48 to 2.73) for peptic ulcer disease. CONCLUSION: Partners of people with specific diseases are at increased risk of the disease themselves-at least 70% increased risk for asthma, depression, and peptic ulcer disease. This implicates shared environmental causes in some diseases in addition to any genetic or distant exposure or shared behaviours with respect to seeking health care.

Adult↗

PubMed2002

A comparison of research general practices and their patients with other practices--a cross-sectional survey in Trent.

BACKGROUND: When interpreting results of studies undertaken by research networks we need to know how representative volunteer practices and their registered patients are of the total population of practices and patients in their locality. AIM: To compare the following in research and non-research general practices in one region: practice and population demography, morbidity and mortality, selected performance indicators, and health outcomes. DESIGN OF STUDY: Cross-sectional survey. SETTING: Sixty-six Trent Focus Collaborative Research Network general practices and 749 other general practices in Trent, United Kingdom. METHOD: Practice characteristics and GP contract data were obtained from the NHS Executive, Quarry House, Leeds. The Trent Regional NHS Hospital Admission Database was searched to identify all relevant admissions to hospital from all practices between 1 April 1993 and 31 March 1997. Ward-linked data on cancer were obtained from the Trent Cancer Registry. RESULTS: Of the 815 general practices in Trent Region in the study period, 66 (8%) were in the Trent Focus network. They were more likely to be involved in training GPs and to have a female partner. They tended to be larger, with fewer single-handed doctors and younger GPs. Network practices prescribed a higher proportion of generics (median % prescribed/practice = 70%, versus 51%, Mann-Whitney U = 1615, P<0.0001). There were no clinically important differences between hospital admission rates between the two groups or waiting times for surgical procedures. There was no difference in the incidence of cancer and standardised mortality ratios related to the electoral wards of the GP surgery. CONCLUSION: Although there were differences in practice structure and some aspects of performance, we found no important differences in the demography of registered patients, nor in morbidity, mortality, or access to or use of secondary care.

Cross-Sectional Studies↗