The contribution of qualitative approaches to musculoskeletal research.
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Attitude to Health↗
Biomedical subjects
B N Ong
Publications and source records attributed to B N Ong.
A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over.
OBJECTIVE: To use a brief screening tool to identify knee pain (all knee pain, non-chronic and chronic knee pain) and associated health-care use in the general population aged 50 yr and over. METHODS: A cross-sectional survey was mailed to 8995 individuals registered with three general practices in North Staffordshire, UK. The questionnaire included a Knee Pain Screening Tool (KNEST), the Short Form 36 (SF36), demographic questions and, for those who reported knee pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: The survey achieved a 77% response. The 12-month period prevalence of all knee pain was 46.8% [95% confidence interval (CI) 45.6%, 48.0%]. Figures for non-chronic knee pain (pain of less than 3 months duration) and chronic knee pain (pain of more than 3 months duration) were 21.5% (95% CI 20.5%, 22.5%) and 25.3% (95% CI 24.3%, 26.4%) respectively. An estimated 6% of the older population had non-chronic but severe knee pain or disability. Thirty-three per cent of all knee pain sufferers had consulted their general practitioner (GP) about their symptom in the last year. This included 34% of those with non-chronic but severe knee pain or disability and 56% of those with chronic and severe knee pain or disability. The use of private treatments or services for knee pain was minimal. A third of those with chronic and severe knee pain or disability had not used any services (including GP) in the last year. CONCLUSIONS: The KNEST is a simple tool for the identification of individuals with knee pain and their health-care use. Focusing only on chronic knee pain will underestimate the total need and demand for health-care in knee pain sufferers in the general older population, as non-chronic as well as chronic knee pain has a significant impact on people's lives and on their use of primary health-care. The KNEST, when combined with the WOMAC, identifies population groups who have potentially diverse health-care needs and who might benefit from effective health-care. These data can be used alongside evidence on effective treatments by service planners when considering needs for the care of older adults in primary care.
Aged↗
Previous consultation and self reported health status as predictors of future demand for primary care.
STUDY OBJECTIVE: There has been little prospective investigation of what predicts general practice consultation. The objective of this study was to investigate the extent to which previous primary care consultation and self reported health status are predictors of future primary care consultation. DESIGN: Population based cohort study in two phases. Firstly, a baseline survey (1995/96) to identify the cohort and to obtain self reported health status using the UK census limiting long term illness (LLI) question and the Short Form-36 (SF-36) health profile. Secondly, analysis of general practice medical records for two years (1994/1995) before the survey and for two years (1997/1998) after the survey. Analysis was performed on: (a) all contacts coded by the GP, (b) the subgroup of contacts given a diagnostic morbidity code by the GP. SETTING: One general practice in North Staffordshire, UK. PARTICIPANTS: 738 survey respondents who had consented to viewing of medical records including all those who reported LLI together with an age-gender matched control group of those who reported no LLI. MAIN RESULTS: High frequency consulters in 1994/95 were more likely than non-consulters or average consulters in that year to be high consulters in 1997/98 (odds ratio 5.6, 95% confidence interval 3.82 to 8.25, for all contacts; 4.4 for diagnostic coded consultations). Self reported role disability and physical limitation from the SF-36 at baseline increased the probability of being a future high consulter but the effects were weaker than for previous consultation. Previous consultation within a diagnostic group was the main predictor for future consultation within that group with weaker but significant prediction by self reported health status. CONCLUSIONS: Reliable morbidity coding in general practice provides the best available basis for predicting future demand in primary care. Self reported health status survey instruments add to this information but on their own are weaker predictors of future consultation.
Adult↗
Primary care trusts: the way forward?
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Health Care Reform↗
Postal surveys in primary care: the hidden burden.
OBJECTIVE: To investigate and analyse concerns raised by unsolicited mailing of a health survey to a community sample of older people. DESIGN: Observation and monitoring of all telephone calls received throughout a 6-week survey mailing period. SETTING AND PARTICIPANTS: A total sample of all those aged over 50 years registered with three general practices in North Staffordshire (n=8995). MAIN VARIABLE STUDIED: The frequency of telephone contact following the receipt of a postal questionnaire, and the nature of any associated distress. RESULTS AND CONCLUSIONS: Individuals who receive unsolicited postal surveys may experience anxiety because of the actual receipt of the questionnaire, concerns about taking part or not taking part, personal issues, anger, worthiness or frustration with NHS services. Anxiety may also be triggered because of administrative issues, for example lost mail or overlap between mailing periods. Researchers can adopt measures both to reduce the potential anxiety and often hidden burden of postal surveys, and to facilitate individuals' positive participation in research.
Aged↗
A brief screening tool for knee pain in primary care. 1. Validity and reliability.
OBJECTIVES: To design and test the performance of a new knee pain screening tool (KNEST), both separately and together with a combination of existing questionnaires, which will be used to assess the general health status of knee pain sufferers in primary care. METHODS: A postal survey of knee pain and disability was sent to a random sample of 240 individuals aged over 55 yr registered with two general practices in North STAFFORDSHIRE: The survey questionnaire consisted of the KNEST; a pain manikin; the Short Form 36 (SF-36); the Hospital Anxiety and Depression Scale (HADS); demographic questions; and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for those who reported knee pain. A second, identical questionnaire was sent 2 weeks later to a random subsample of responders (n=80) to test repeatability. RESULTS: An 85% baseline response rate was achieved for the first questionnaire. The 12-month prevalence of knee pain identified from baseline responders to the survey was 45%. A response rate of 74% was achieved for the repeatability questionnaire. Each section of the questionnaire was well completed and repeatability was good for nearly all measures (most reliability scores exceeded 0.6). A new core question about knee pain showed good internal reliability, with an agreement score of 91% between baseline and retest assessment, and good construct validity in relation to knee pain identified on the pain manikin (agreement 95%). Good agreement was found between recalled consultation for knee pain in the questionnaire and evidence of consultation for knee pain in general practice records. CONCLUSIONS: The KNEST appears to be a reliable and valid composite tool for the study of population needs and outcomes of care for people aged over 55 yr with knee pain.
Disability Evaluation↗
Mobile medics? The mobility of doctors in the European Economic Area.
The Treaty of Rome seeks to generate a common European market whereby all barriers to the free movement of produce, capital, services and labour are removed. Current EU policy on the free movement of labour requires that healthcare workers, who are EU citizens and meet certain training criteria, have the right to register to practice in member states other than the one in which they trained. This policy is underpinned by the EEC Directives. For example, the Medical Directive 93/16/EEC describes the framework for the mutual recognition of medical diplomas, certificates and other evidence of qualifications through out the European Economic Area (EEA). The potential impact of this for health policy is clear-workforce planning and the demand for doctors, (and also nurses and other health care professionals), could be particularly affected by new forces impacting on their supply. This paper reports on the reality of labour mobility today, and on the factors upon which mobility depends, by the means of a case study which, investigated the movement into UK of doctors from the EEA. At a formal level there is mutual recognition of diplomas, certificates and other evidence of qualifications. However, formal and 'real life' recognition could be in tension equating in policy terms to an implementation deficit. As a result, there is a 'mixed picture' which makes predicting the future (both for individual countries and for the European Union) even more difficult. Furthermore, different policy objectives have to be reconciled. Do we want high mobility; or do we want to preserve national manpower planning?
Certification↗
Researching limiting long-term illness.
Needs assessment has become one of the cornerstones for commissioning health care in the UK but, as yet, no agreed methodological framework exists. This study attempts to build on a number of different approaches used in needs assessment in order to formulate a more complex and integrated model. We have taken limiting long-term illness (LLI) as a starting point and examined its prevalence within the primary care setting in an area of North Staffordshire. This was followed by the application of a health status measure on two sub-samples (those reporting LLI and those not reporting LLI). The diagnostic assessments of the GP was placed alongside the results of the health status measure in order to compare self-assessment with the professional perspective. Finally, in-depth interviews with people with LLI were carried out examining their own experience of ill-health. We argue that this detailed and complex needs assessment allows for a more targeted approach to commissioning and service development.
Chronic Disease↗
The reliability of the three-dimensional FASTRAK measurement system in measuring cervical spine and shoulder range of motion in healthy subjects.
OBJECTIVES: To assess the inter-observer and intra-observer reliability of a new three-dimensional measurement system, the FASTRAK, in measuring cervical spine flexion/extension, lateral flexion and rotation and shoulder flexion/extension, abduction and external rotation in healthy subjects. METHODS: The study was conducted in two parts. One part assessed inter-observer reliability with two observers measuring 40 subjects. The other part assessed intra-observer reliability with one observer measuring 32 subjects on three occasions. All subjects had unrestricted, pain-free cervical spine and shoulder movement. Reliability was measured by the intraclass correlation coefficient [ICC(2,1)]. RESULTS: The inter-observer ICCs for the cervical spine ranged from 0.61 to 0.89 and for the shoulder from 0.68 to 0.75. After removal of outliers, all ICCs were above 0.70. Intra-observer ICCs for the cervical spine ranged from 0.54 to 0.82 and for the shoulder from 0.62 to 0.81. After removal of outliers, all ICCs were above 0.70 except for shoulder abduction (0.62). CONCLUSIONS: Whilst all movements measured by the FASTRAK showed good reliability, the reliability of the whole movement in a plane (e.g. left plus right lateral flexion) was better than for the separate movements (e.g. left and right lateral flexion taken separately). Inter-observer reliability was generally better than intra-observer reliability for most cervical spine movements, suggesting that variability of movement within subjects (e.g. over a period of days) for these movements was greater than variability between measures on the same occasion.
Adult↗
Workforce planning. Catching the drift.
NHS workforce planning has traditionally ignored the role of doctors and nurses trained in continental Europe and Scandinavia. At present doctors trained in the European Economic Area make up 10 per cent of senior house officers in England and Wales. But the numbers coming to the UK are falling. Falling medical unemployment in Europe will mean these doctors have less incentive to come to the UK, leaving a considerable gap in the NHS workforce. More local research is needed into working patterns and career plans of European-trained nurses and doctors.
European Union↗
Comparative perspectives on doctors in management in the UK and The Netherlands.
The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK highlight that several models of medical management are formulated and exist alongside each other, leading to more flexibility in the roles of both doctors and managers. In particular, the agendas concerning the quality of clinical care and cost-effectiveness are converging, emphasising the increasingly important role of medical managers.
Decision Making, Organizational↗
Analysing the medicine-management interface in acute trusts.
The impact of the NHS reforms, and the resulting purchaser-provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management-medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.
Health Care Reform↗
The lay perspective in health technology assessment.
Health technology assessment has predominantly been carried out by scientific and health policy experts, but the involvement of users is becoming increasingly important. At present, robust examples of the integration of lay knowledge in health technology assessment are limited, but examination of examples in other fields of health policy decision making can provide important pointers for the development of valid methodologies.
Community Participation↗
Women in management. Her master's voice.
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Administrative Personnel↗
The development of minimally invasive therapy in the United Kingdom.
The diffusion of minimally invasive therapy (MIT) must be understood against the background of sweeping changes in the organisation and funding of the National Health Service (NHS) in the UK. The separation of purchasers from providers of health care makes national policy, in theory, less important, as local developments are supposed to drive the process of needs assessment and resource allocation. Within this climate new technologies increasingly have to prove their cost-effectiveness. Yet the country case study illustrates that such studies lack established methodologies and wide application. One of the key barriers to diffusion lies within the profession itself, where resistance to paradigmatic change is the strongest force against innovation. The partnership between innovative clinicians and forward-looking managers is important if diffusion of new procedures is to be secured. The discussion of the 10 examples will highlight some of these important issues.
Angioplasty, Balloon, Coronary↗
Countdown to community care. Job sharing.
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Budgets↗
Rapid appraisal in an urban setting, an example from the developed world.
Rapid Appraisal has been used as a method to understand communities' own perceptions of their priority needs. It can be used as a tool for formulating joint action plans between communities and service planners and managers. It can also be used to complement quantitative methods of assessing needs by more in-depth qualitative understanding of socio-cultural perspectives. In the example described in this paper Rapid Appraisal is used both as action research and as a qualitative tool in order to define health and social needs of an urban, deprived community in England.
Community Health Services↗
Researching needs in district nursing.
This paper describes the first stage of a research project aimed at understanding the needs of clients (and their carers) of district nursing services. The project applies a pluralistic research design, combining qualitative and quantitative methods. Through the use of an ethnographic approach, concepts of needs are generated which are related to how clients and carers perceive themselves and the role of the district nurse. The study attempts to formulate needs within a contextual framework against which an activity analysis of district nurses' work (stage 2) can be evaluated.
Clinical Competence↗