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Biomedical subjects

B Jarman

Publications and source records attributed to B Jarman.

At least 19 recordsLinked to original sources
PubMed1996

The Swedish UPA score: an administrative tool for identification of underprivileged areas.

The purpose was to construct a Swedish social deprivation index analogous to the underprivileged area (UPA) score, used in the UK to distribute resources to general practice for patients resident in the most underprivileged areas. UPA scores were calculated using 1990 Swedish census data and the 1992 unemployment and migration registers for all 8,502 SAMS (small area market statistics) areas with more than 50 inhabitants. Selection of the eight variables included in the score and weights attached to each were derived from a national survey of general practitioners in the UK representing the degree to which they considered that each factor increased their workload or pressure on services. The UPA score for each area is the sum of the eight normalised (arc sin square root), standardised (z scores) and weighted variables for that area. The distribution of UPA scores ranged from -79.13, in the most affluent areas to 46.10 in the most underprivileged areas. It was found that a wide range of social deprivation exists at small area level.

England↗
PubMed1996

Underprivileged area score, ethnicity, social factors and general mortality in district health authorities in England and Wales.

OBJECTIVE: To analyse the relation of ethnicity, social deprivation (Underprivileged area, UPA-score), social class V, unemployment and overcrowding on age- and sex-standardized mortality ratio (SMR). DESIGN: This ecological study used the SMR for people under the age of 65 years as dependent variable. Mortality data for 1983, classified by total population of country of birth (New Commonwealth and Pakistan), unskilled (social class V), unemployed, and overcrowded (>1/room) population with data from 1981 censuses. Underprivileged Area (UPA) score was applied in this study, an index widely used in the UK to identify underprivileged residential areas, calculated from information combining eight variables derived from the decennial census. The data were analysed by multiple regression (least square estimation) with SMR as dependent variable and the other social factors as independent variables. SETTING: All 192 district health authorities in England and Wales. RESULTS: There was a significant association between UPA-score and SMR (R-square = 0.53, p = 0.0001). The second model included the four variables: % unskilled, % unemployed of economically active population, % of residents living in overcrowded households, and % of population from New Commonwealth and Pakistan. This model explained about 77% of the variance. All variables were significant. All coefficients except ethnicity were positive, i.e. the higher the coefficients, the higher the SMR. CONCLUSION: This paper shows that social deprivation, unemployment and overcrowding were related to mortality in district health authorities in England and Wales. The finding that ethnicity was inversely related to general mortality might be important and needs to be further analysed.

Adolescent↗
PubMed1995

Measuring disadvantage: changes in the underprivileged area, Townsend, and Carstairs scores 1981-91.

OBJECTIVE: To compare the intercensal change for each of the underprivileged area (UPA), Townsend, and Carstairs scores calculated from 1981 and 1991 census data. SETTING: England and Wales. METHODS: The method described enables comparison of change in composite scores such as the UPA, Townsend, and Carstairs scores which are derived from normalised variables. The national values of equivalent variables derived from the censuses are calculated and normalised on the same baseline of the 1981 electoral ward mean and SD values. The resultant change in composite scores for different censuses can then be compared directly. MAIN OUTCOME MEASURE: Change in the composite score values for the 1991 census when compared with the 1981 census. RESULTS: For England and Wales, the UPA score increased by 5.62 units (0.35 of the SD) but the Townsend and Carstairs scores fell by 2.39 and 1.13 units respectively (0.71 and 0.33 of the SDs). CONCLUSION: The Townsend and Carstairs scores are good measures of material deprivation and show a general improvement as such between 1981 and 1991. The UPA score, however, includes additional factors relating to family structure, social deprivation, and health need and shows a decline in the overall situation.

Data Interpretation, Statistical↗
PubMed1994

National survey of hospital patients.

OBJECTIVE: To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN: Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS: 5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES: Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS: Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS: This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened rather than how satisfied they were with treatment can elucidate the problems that exist and so enable them to be solved.

Adolescent↗
PubMed1993

Is London overbedded?

OBJECTIVE: To examine whether there are too many hospital beds in London. DESIGN: Analysis of data from the Hospital In-Patient Enquiry, Mental Health Enquiry, health service indicators, and Emergency Bed Service. SETTING: England, London, and inner London. RESULTS: Hospital admission rates for acute plus geriatric services for London residents were very similar to the national values in all age groups. In the special case considered in the Tomlinson report--acute services in inner London--the admission rate was 22% above the value for England. However, the admission rate of inner deprived Londoners was 9% below that of comparable areas outside London. For psychiatry, admission rates in London roughly equalled those in comparable areas. When special health authorities were excluded, in 1990-1 there were 4% more acute plus geriatric beds available per resident in London than in England. Bed provision has been reduced more rapidly in London than nationally. Extrapolating the trend of bed closures forward indicates that beds (all and acute) per resident in London are now at about the national average. Data from the Emergency Bed Service indicate that the pressure on available hospital beds in London has been increasing since 1985. CONCLUSIONS: Data regarding bed provision and utilisation for all specialties by London residents do not provide a case for reducing the total hospital bed stock in London at a rate faster than elsewhere. Bed closures should take account of London's relatively poorer social and primary health care circumstances, longer hospital waiting lists, poorer provision of residential homes, and evidence from the Emergency Bed Service of increasing pressure on beds. Higher average costs in London, some unavoidable, are forcing hospital beds to be closed at a faster rate in London than nationally.

Acute Disease↗
PubMed1993

Perceived strategic and practical problems in the use of information technology for quality improvement in diabetes care in the United Kingdom.

Quality Assurance in Diabetes Care is a new aspect of our National Health Service Reforms linked to the publication of a Patient's Charter. If current pressures are maintained, most diabetics in UK will soon receive their diabetes care from their General Practitioner, often based in a Group Practice where structured care for chronic diseases is more easy to organise. Large inner cities like London have special problems not adequately addressed in resource allocation. Penetration of computers into General Practice is forecast in many areas to be approaching 100% within the next two years but few systems will be able to provide useful support for structured diabetes care. Organisational issues concerning treatment protocols, contracts for care, quality assessment and audit are daunting and will take time to agree and install. The British Diabetic Association and The Royal College of Physicians have a joint initiative in developing a National Audit Dataset for Diabetes Care which is compatible with WHO's DiabCare. Current information systems in hospital and community care are inadequate to monitor the St Vincent "End points" and it is unlikely that things will improve sufficiently quickly to either facilitate or document progress towards the St Vincent Objectives. The Government have not included diabetes in their strategic plans for the next five years. As a result, it seems unlikely that Diabetes Care in the UK will meet the St Vincent Objectives by 1995.

Age Factors↗
PubMed1992

Tomlinson report.

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Family Practice↗
PubMed1992

Primary health care in London--changes since the Acheson report.

OBJECTIVE: To examine changes in primary care in London in the 11 years since the Acheson report on primary health care in inner London. DESIGN: Analysis of key data from the family health services authority performance indicators and from the Department of Health; study of trends since the time of the Acheson report; examination of the provision of primary care in 1990-1 and its relation to health and social factors. SETTING: Comparisons between the family health services authorities of inner London, outer London, and England as a whole, with a special study of Birmingham, Liverpool, and Manchester. SUBJECTS: The family health services authorities of England. RESULTS: There has been an improvement in the provision of primary care in inner London as judged by the criteria of the Acheson report, but these improvements have occurred only as part of an overall improvement in the provision of primary care in the country as a whole. None of the recommendations of the Acheson report specifically oriented to London have been implemented. There are some worrying trends in inner London, such as the increasing proportion of practices with more than 2500 patients. The problems faced by practitioners in inner London resemble those in other large inner city areas, but the primary care provision to deal with them is relatively poor.

Family Health↗
PubMed1992

Predicting psychiatric admission rates.

OBJECTIVE: To determine the numbers of actual and expected psychiatric admissions for the residents of the district health authorities of England and to develop a model to indicate which social, health status, and service provision factors best explain the variation of the actual from the expected psychiatric admissions; to use this model to predict psychiatric admission for district health authorities as an aid to resource allocation. DESIGN: The actual psychiatric admission for district health authority residents were extracted from data of the 1986 Mental Health Enquiry. Expected admissions were calculated using the age, sex, and marital status structure of each district health authority and the national psychiatric admission rates related to age, sex, and marital status. Standardised psychiatric admission ratios were calculated as the ratios of the numbers of actual to expected psychiatric admissions. A wide range of social, health status, and service provision data were used as the explanatory variables in regression analyses to determine which combination of factors best explained the variation between districts of standardised psychiatric admission ratios. SETTING: The 168,652 psychiatric admissions recorded for the 1986 Mental Health Enquiry, after exclusion of mental handicap and psychogeriatric admissions. RESULTS: The actual number of psychiatric admissions varied from 79% above to 54% below the expected number of admissions from age, sex, and marital status for the districts of England. The most powerful variables to explain this variation were the rate of notification of drug misusers, standardised mortality ratios, and levels of illegitimacy in each district. A complex model was developed which could be used to predict district psychiatric admissions as an aid to resource allocation. A simpler model was also developed (which was less powerful than the more complex model) based on the underprivileged area score. One advantage of this model was that it could be used at the level of electoral wards as well as district health authorities.

Adolescent↗
PubMed1992

Care plans for the operating department.

Very little, if any, of the care administered by the theatre staff within operating theatres has ever been fully documented. The person 'scrubbed' for the case and the circulating person accountable for the final swab, instrument and needle checks, sign their names in a ledger within theatre. A verbal exchange relating to the patient's operation, the dressings applied, any drains or implants in situ etc. may take place between the 'scub' person and the nurse into whose care the patient is to be entrusted. It is little wonder that we in theatres appear to have lost our identity as nurses and the role envisaged by our colleagues is one of a technician or that of being the surgeon's 'hand-maiden'! As stated in a previous Journal, 'The failure to define the nurse's role in the theatre can only mean one of two things--either nursing is not clearly demonstrated by theatre nurses or nursing does not exist within operating theatres'.

Forms and Records Control↗
PubMed1991

Jarman index.

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Health Status Indicators↗