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Biomedical subjects

A Coulter

Publications and source records attributed to A Coulter.

At least 55 records · Page 3Linked to original sources
PubMed1995

Influence of sex of general practitioner on management of menorrhagia.

BACKGROUND: There is an assumption that men and women general practitioners adopt different practice styles in the management of gynaecological disorders. However, there is little evidence to support this view. AIM: A study was undertaken to compare the practice styles of men and women general practitioners in the management of menorrhagia. METHOD: The study took place in 73 general practices in the Oxford Regional Health Authority area. A total of 348 patients who consulted 74 men general practitioners and 43 women general practitioners with a complaint of menorrhagia were recruited into the study and completed postal questionnaires nine and 18 months after entry into the study. Main outcome measures were men and women general practitioners' awareness of patients' treatment preferences, treatment received by patients, patients' involvement in treatment decisions and patients' satisfaction with treatment received. RESULTS: There were no statistically significant differences in treatment received by patients of men and women general practitioners. Fewer patients consulting women general practitioners were referred to a gynaecologist compared with patients consulting men general practitioners (56% versus 64%) and fewer underwent surgery (39% versus 47%). More patients consulting women general practitioners reported participation in treatment decisions (63% versus 53%) but more patients consulting men general practitioners were satisfied with the care they received (66% versus 55%). Again, these differences were not statistically significant. CONCLUSION: Although some indications of sex-associated differences in practice style were found in this study, the similarities in practice styles of men and women general practitioners were more striking than the differences.

Adult↗
PubMed1994

Measuring change over time: a comparison of results from a global single item of health status and the multi-dimensional SF-36 health status survey questionnaire in patients presenting with menorrhagia.

This paper compares the sensitivity to change of a multi-item, multi-dimensional health status measure with a single global health status question, in the assessment of treatment for menorrhagia. A cohort study of patients recruited by general practitioners, was carried out, with a follow up at eighteen months. Questionnaires were administered postally at base-line and follow up. General practices in Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire supplied three hundred and nine women who reported heavy menstrual bleeding, and received either drug treatment alone or both drug and surgical treatment (endometrial resection or hysterectomy) during the eighteen months between the two administrations of the questionnaires. A single global question was given to patients asking them to rate their overall health status as 'excellent', 'very good', 'good', 'fair' or 'poor'. The eight dimensions of the SF-36 health survey questionnaire were also given to patients to complete. The dimensions of the SF-36 indicated only small levels of improvement for patients who received drug treatment. However, on many dimensions of the SF-36, a moderate to large improvement was detected for the surgical group. However, small changes were reported in overall health status, as indicated by the single global question, for both groups. Single item measures of health status may not provide a sufficiently accurate indication of health status to be appropriate for use in longitudinal studies.

Adult↗
PubMed1994

Criterion validity and reliability of the SF-36 in a population sample.

This study aimed to determine the criterion validity of the Short Form 36 health survey questionnaire (SF-36) in a large community sample, and to explore the instrument's internal consistency and validity in groups reporting different levels of ill-health. A postal survey was undertaken using a questionnaire booklet, containing the SF-36 and a number of other items concerned with lifestyles and illness. The questionnaire booklet was sent to 13,042 randomly selected subjects between the ages of 18-64 years, drawn from Family Health Services Authority (FHSA) computerized registers for Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire. This paper is based upon the 9332 (72%) responses gained. Scores for the functional status and well-being scales of the SF-36 were used as outcome measures. The response rate for the questionnaire booklet was 72%. Internal consistency of domains was found to be high, both for the sample as a whole, and when broken down by specific subgroups. Criterion validity was assessed by comparing scores for the seven multi-item dimensions assessing functional status and well being with a single global health question. The global question was the first item of the SF-36 and asks respondents to evaluate their health 'overall'. Statistically significant trends were observed for decreasing SF-36 scores (i.e., those indicating greater health problems) with worsening self-rated general health. These results provide further psychometric evidence for the use of the SF-36 when used with groups reporting varying extents of ill-health.

Adolescent↗
PubMed1994

Assembling the evidence: patient-focused outcomes research.

Wide variations in medical practice point to the need for better information about the effectiveness of medical interventions derived from well-conducted outcomes studies. The best outcomes research is patient-focused. The example of hysterectomy is used to illustrate the type of information patients need if they are to be active participants in decisions about their care. These decisions are complex, involving the weighing up of a number of potential risks, benefits and uncertainties. Patients as well as doctors need reliable summaries of the evidence to promote shared decision-making and to increase the chance of beneficial health outcomes.

Female↗
PubMed1994

Patients' preferences and general practitioners' decisions in the treatment of menstrual disorders.

The aim of this study was to investigate the treatment preferences of patients consulting their general practitioners (GPs) for heavy menstrual bleeding and the influence of these preferences and other factors on GPs' management decisions. One-hundred and twenty-nine GPs recruited 483 eligible patients into the study, of whom 425 (88.0%) returned completed questionnaires. 35.6% of patients indicated that they had a strong treatment preference. Logistic regression analysis revealed that the strongest independent predictors of the likelihood of having a treatment preference were higher education and previous consultations for gynaecological problems. Among those who expressed a preference for either drug therapy or surgery, those with severe symptoms and those who had not received higher education were more likely to prefer surgical treatment. The likelihood of referral was related to a preference for surgery, as expressed by the patient and as perceived by the GP. Patients were much more likely to be referred to a gynaecologist if they had a history of prior surgery (odds ratio 3.21) and if their GP was male (odds ratio 1.76).

Adult↗
PubMed1994

Quality of life and patient satisfaction following treatment for menorrhagia.

This prospective cohort study of patients who consulted general practitioners complaining of excessive menstrual bleeding measured changes in quality of life and patients' satisfaction following different forms of treatment for menorrhagia. Three hundred and forty-eight patients were followed-up for 18 months using self-completion questionnaires which included generic measurements of health-related quality of life (SF-36) and a disease-specific questionnaire to measure the social impact of menstrual symptoms. Only 15 patients (4%) received no active treatment, 132 (38%) underwent surgical treatment (hysterectomy or endometrial resection), and the remainder were prescribed drugs. Those in the surgical group with both moderate and severe symptoms experienced significant improvements in their quality of life. Patients with moderate symptoms who did not undergo surgery improved in the social functioning and energy dimensions of the SF-36, but those with severe symptoms who received drug treatment only experienced no significant quality-of-life benefits. Patients who had not had surgery were significantly more likely to be dissatisfied with their treatment (21%) than those in the surgical group (5%). Since menorrhagia can have adverse effects on many aspects of a patient's daily life, it is important to measure the effects of treatment on quality of life. This study has demonstrated the feasibility of doing so.

Activities of Daily Living↗
PubMed1993

Effect of fundholding and indicative prescribing schemes on general practitioners' prescribing costs.

OBJECTIVE: To compare general practitioners' prescribing costs in fundholding and non-fundholding practices before and after implementation of the NHS reforms in April 1991. DESIGN: Analysis of prescribing and cost information (PACT data; levels 2 and 3) over two six month periods in 1991 and 1992. SETTING: Oxford region. PARTICIPANTS: Three dispensing fundholding practices; five non-dispensing fundholding practices; and seven non-dispensing, non-fundholding practices. MAIN OUTCOME MEASURES: Percentage change in net cost of ingredients, number of items prescribed, average cost per item, and proportion of generic drugs prescribed after NHS reforms. RESULTS: Prescribing costs increased in all practices in the six months after the reforms. The net costs of ingredients increased among dispensing fundholders by 10.2%, among non-dispensing fundholders by 13.2%, and among non-fundholders by 18.7%. The number of items prescribed also increased in all three groups (by 5.2%, 7.5%, and 6.1% respectively). The increase in average cost per item was 4.8% for dispensing fundholders, 5.3% for non-dispensing fundholders, and 11.9% for non-fundholders. Dispensing fundholders increased the proportion of generic drugs prescribed from 26.9% to 34.5% and non-dispensing fundholders from 44.5% to 48.7%; non-fundholders showed no change (47%). Five of the eight fundholding practices made savings in their drugs budgets at the end of the first year of fundholding (range 2.9-10.7%; the three other practices overspent by up to 3.6%). All non-fundholding practices exceeded their indicative prescribing amounts (range 3.2-20.0%). CONCLUSIONS: Fundholding has helped to curb increases in prescribing costs, even among dispensing general practitioners, for whom the incentives are different. Indicative prescribing amounts for non-fundholding practices do not seem to have had the same effect.

Drug Costs↗
PubMed1993

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Health Services Research↗
PubMed1993

Cardiovascular risk and attitudes to lifestyle: what do patients think?

OBJECTIVE: To examine the relation between subjects' level of cardiovascular risk and their beliefs about the harmfulness of their smoking habit, current diet, and level of exercise, together with their stated desire to modify such behaviour. DESIGN: Self administered postal health and life-style questionnaire followed by a structured health check conducted by a nurse. SETTING: Five general practices in Luton and Dunstable, Bedfordshire. SUBJECTS: 5803 people aged 35-64 years enrolled in the OXCHECK trial who attended for a health check before 1 March 1992. MAIN OUTCOME MEASURES: Perceived risk to health of lifestyle behaviours, desire to modify behaviour, and a reported serious attempt to modify behaviour in the preceding year. RESULTS: A high proportion of smokers and those who were physically inactive perceived their behaviour to be harmful (1020; (76%; 95% confidence interval 74% to 79%) and 350 (74%; 70% to 78%) respectively) and wished to modify it (1212 (79%; 77% to 81%) and 375 (74%; 71% to 78%) respectively). In contrast, only 289 (45%; 41% to 48%) of obese people and 188 (14%; 12% to 16%) of people with a high dietary fat intake perceived their current diet to be harmful. The more cardiovascular risk factors present, the more likely subjects were to perceive a health risk attached to their diet and lack of exercise (p < 0.01 in both cases) and to want to improve their diet. CONCLUSION: Awareness of the health risk from smoking and motivation to stop is high. Further efforts are required, however, to educate the public about the risks associated with a high dietary fat intake. Although the health risks of inactivity were widely recognised, motivation to take more exercise needs to be increased.

Adult↗
PubMed1993

Short form 36 (SF36) health survey questionnaire: normative data for adults of working age.

OBJECTIVES: To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity. DESIGN: Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness. SETTING: The sample was drawn from computerised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. SAMPLE: 13,042 randomly selected subjects aged 18-64 years. MAIN OUTCOME MEASURES: Scores for the eight health dimensions of the SF36. RESULTS: The survey achieved a response rate of 72% (n = 9332). Internal consistency of the different dimensions of the questionnaire was high. Normative data broken down by age, sex, and social class were consistent with those from previous studies. CONCLUSIONS: The SF36 is a potentially valuable tool in medical research. The normative data provided here may further facilitate its validation and use.

Adolescent↗
PubMed1993

Effect of NHS reforms on general practitioners' referral patterns.

OBJECTIVE: To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the implementation of the NHS reforms in April 1991. DESIGN: Prospective collection of data on general practitioners' referrals to specialist outpatient clinics between June 1990 and March 1992 and detailed comparison of two time periods: October 1990 to March 1991 (phase 1) and October 1991 to March 1992 (phase 2). SETTING: 10 fundholding practices and six non-fundholding practices in the Oxford region. SUBJECTS: Patients referred to consultant outpatient clinics. RESULTS: After implementation of the NHS reforms there was no change in the proportion of referrals from the two groups of practices which crossed district boundaries. Both groups of practices increased their referral rates in phase 2 of the study, the fundholders from 107.3 per 1000 patients per annum (95% confidence interval 106 to 109) to 111.4 (110 to 113) and the non-fundholders from 95.0 (93 to 97) to 112.0 (110 to 114). In phase 2 there was no difference in overall standardised referral rates between fundholders and non-fundholders. Just over 20% of referrals went to private clinics in phase 1. By phase 2 this proportion had reduced by 2.2% (1.0% to 3.4%) among the fundholders and by 2.7% (1.2% to 4.2%) among the non-fundholders. CONCLUSIONS: Referral patterns among fundholders and non-fundholders were strikingly similar after the implementation of the NHS reforms. There was no evidence that fundholding was encouraging a shift from specialist to general practice care or that budgetary pressures were affecting general practitioners' referral behaviour.

Adolescent↗
PubMed1993

Diagnostic dilatation and curettage: is it used appropriately?

OBJECTIVE: To determine patterns of use of dilatation and curettage in Britain as compared with those in the United States; to examine variations in utilisation rates within one regional health authority. DESIGN: Analysis of routinely collected hospital inpatient statistics. SETTING: Statistics for England, Scotland, and the United States; local statistics for Oxford region. SUBJECTS: All inpatient episodes in which dilatation and curettage was performed but excluding those related to pregnancy. RESULTS: Dilatation and curettage rates remained stable in Britain between 1977 and 1990, whereas in the United States they declined dramatically. In 1989-90 the rate was 71.1 per 10,000 women in England as compared with only 10.8 per 10,000 in America. In 1989, 6936 women underwent diagnostic dilatation and curettage in the Oxford region, making it the most common elective operation. A total of 2726 (39%) of these women were under 40. There was a more than twofold variation in usage of the procedure among district health authorities within the region and even greater variation in rates in women under 40. The proportion of patients treated as day cases in the district general hospitals ranged from 22% to 82%. CONCLUSIONS: Dilatation and curettage may frequently be used inappropriately. The considerable variations in usage of dilatation and curettage internationally and nationally indicate differences in clinical perception of its appropriateness. This makes it suitable for audit. In developing guidelines it will be important to agree on the most appropriate patients and the relative merits of alternative methods of endometrial sampling. Probably this could result in considerable cost savings at no risk and possibly some benefit to patients.

Adolescent↗
PubMed1993

Factors affecting general practitioners' recruitment of patients into a prospective study.

Many research projects depend on general practitioners (GPs) to recruit patients into the study. As part of a study of patients' experiences of treatment for menorrhagia, completeness of recruitment and the extent of bias introduced by failure to recruit was assessed. Only 129 (41%) of 315 GPs who had agreed to recruit patients actually did so. A review of notes in six practices revealed that only 40 (20.4%) of 196 eligible patients had been recruited. There was some evidence that the recruited patients had more severe symptoms than those not recruited. There was no difference in recruitment rates between male and female doctors, but those who had received a practice visit from a member of the research team recruited more patients. A survey of participating GPs revealed that forgetfulness and time pressures were the main factors inhibiting recruitment.

Adult↗