Alcohol: strengthening the primary care response.
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Alcohol Drinking↗
Biomedical subjects
B Jarman
Publications and source records attributed to B Jarman.
Report of the Inner City Task Force of the Royal College of General Practitioners.
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Family Practice↗
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↗
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↗
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↗
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↗
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↗
Research for the review of RAWP.
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Health Services↗
Unemployment rates: an alternative to the Jarman index?
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Poverty Areas↗
Jarman index.
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Health Status Indicators↗
James Mackenzie lecture 1990. General practice, the NHS review and social deprivation.
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Economic Competition↗
Ethnic differences in consultation rates in urban general practice.
OBJECTIVE: To determine the patterns of consultations with the general practitioner among different ethnic groups and the outcome of these consultations. DESIGN: Retrospective analysis of data from one urban group general practice collected during 1979-81 as part of a research project in seven practices. SETTING: Group general practice in the London borough of Brent with a list size of 10,877 patients in July 1980. SUBJECTS: Patients registered with the practice during the 23 months to April 1981 who accounted for 67,197 consultations. MAIN OUTCOME MEASURES: Ethnic state, sex and social class distribution, and diagnosis of patients consulting and frequency of consultations analysed as standardised consultation ratios and standardised patient consultation ratios. RESULTS: Compared with other ethnic groups male Asians (that is, including those born in Britain and those originating from the Indian subcontinent and east Africa) had a substantially increased standardised patient consultation ratio. Consultation rates for mental disorders--in particular, anxiety and depression--were reduced in all groups of immigrant descent. West Indians consulted more frequently for hypertension and asthma, and their children less frequently with otitis media. Asians consulted more frequently with upper respiratory tract infections and non-specific symptoms. Native British patients were more likely to leave the surgery with a follow up appointment, prescription, or certificate. CONCLUSION: Notwithstanding the limitations of this study, ethnic differences in consultation rates were apparent. These differences require further investigation if the needs of minority ethnic groups are not to be overlooked.
Asia↗
Theatre experience: a useful tool for recruitment?
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Humans↗