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Chris Salisbury

Publications and source records attributed to Chris Salisbury.

28 records · Page 2Linked to original sources
PubMed2003

The provision of 'same-day' care in general practice: an observational study.

BACKGROUND: Surveys suggest that general practice is perceived to be inaccessible, with long delays before it is possible to be seen by a doctor. Although there is demand for rapid access to care, this has the potential to decrease continuity of care, which research consistently shows to be valued by patients but stressful for doctors. OBJECTIVE: Our aim was to investigate the provision of 'same-day' care and the characteristics, treatment expectations and priorities of patients attending for 'routine' and 'same-day' appointments. METHODS: The uptake of same-day and routine appointments was determined from appointment system records. A self-completed questionnaire survey of people attending 362 same-day and 362 routine appointments at 15 general practices in Avon and Gloucestershire enabled comparisons with respect of patient characteristics and consultation experiences, patients' preferences for rapid access, seeing a known practitioner or seeing a doctor rather than a nurse. RESULTS: The uptake per 1000 practice population per day was 7.6 [95% confidence interval (CI) 7.1-8.1] for routine appointments and 3.8 (95% CI 3.5-4.2) for same-day appointments. In univariable analyses, use of same-day care was greater by people who were younger, non-white, in work and with educational qualifications. They had attended the practice less often, waited less time to see a doctor previously, had their current problem for a shorter time and were more likely to expect a prescription. From multivariable analyses, only age, speed of previously obtaining appointments, expecting a prescription and having the problem for a short time were independently associated with receiving same-day care. Rapid access to care was rated as more important than seeing a known doctor for two clinical scenarios. CONCLUSIONS: Much care is provided currently on the day it is requested in general practice. The use of same-day care was related to acute illness and expectations but was not associated with deprivation or patient characteristics apart from age.

Adolescent↗
PubMed2003

Patient group directions for antibiotic supply in Walk-in Centres: how legal are they?

Until recently antibiotics were only available on prescription. Nurses in NHS Walk-in Centres (WiCs) now supply and administer antibiotics in accordance with patient group directions (PGDs). The aim of this study was to investigate the process of antibiotic supply from WiCs. Antibiotic PGDs from ten WiCs were selected and medical notes of 50 patients who received an antibiotic at these WiCs were examined to determine compliance with PGD specifications. No consistency of approach in format and content of PGDs was found. PGDs from six WiCs complied with 15/20 or fewer PGD requirements. In the examination of patients' records, 65% of all relevant PGD requirements were explicitly recorded. The breadth and variability of PGDs demonstrates local needs and priorities; however, low compliance levels with PGD requirements provide cause for concern. This article discusses the legality of PGDs, equity in both service provision and advice offered, compliance of medical notes with PGD requirements, implications for patients and WiC nurses, and training implications. Incomplete documentation makes it impossible to verify the quality of care provided across and within WiCs. It also suggests that uncertainty remains around the supply of medicines under PGDs.

Ambulatory Care Facilities↗
PubMed2003

Walk-in centres in primary care: a review of the international literature.

Nurse-led walk-in centres were first announced in April 1999. They represent a new development in unscheduled care provision in the United Kingdom (UK) National Health Service (NHS). By the end of 2000, 40 NHS walk-in centres had been opened, with further centres recently announced. This paper aims to review international experience with walk-in centres in primary and emergency care and identify relevant lessons for the UK. This study is a systematic review, with qualitative synthesis of relevant findings. Studies were identified from seven major bibliographic databases using a sensitive search strategy, and 244 relevant documents relating to walk-in or 'ambulatory care' centres were identified. Users of walk-in centres in other countries tend to be a relatively affluent population of working age, and a different population from those using conventional general practice services. Walk-in centres are used particularly when other health services are closed. The problems presented are mainly minor illnesses and minor injuries. People choose this form of care mainly for reasons of convenience, and satisfaction with the service is generally high. The very limited evidence available suggests that walk-in centres provide care of reasonable quality, but there is insufficient evidence to draw firm conclusions about the impact of walk-in centres on other healthcare services or the costs of such care. Although a number of countries have had a long experience of walk-in centres, the lack of reliable evidence on many of the most important issues is notable. In the NHS, walk-in centres represent a radically innovative attempt to improve access to health care, but the limited research available does little to inform their development. Important questions that need to be addressed include whether walk-in centres do improve access to care, for whom, and at what overall cost.

Ambulatory Care Facilities↗
PubMed2002

An observational study comparing quality of care in walk-in centres with general practice and NHS Direct using standardised patients.

OBJECTIVES: To compare the quality of clinical care in walk-in centres with that provided in general practice and by NHS Direct. DESIGN: Observational study involving assessment of clinicians by standardised patients. SETTING: 20 walk-in centres, 20 general practices, and 11 NHS Direct sites. PARTICIPANTS: 297 consultations with standardised patients, 99 in each setting, carried out by professional role players trained to play five clinical scenarios (postcoital contraception, chest pain, sinusitis, headache, and asthma). MAIN OUTCOME MEASURES: Primary outcomes were mean scores on consensus derived checklists of essential items for the management of the clinical scenarios. Data were also collected on access to and referral by walk-in centres, general practices, and NHS Direct. RESULTS: Walk-in centres achieved a significantly greater mean score for all scenarios combined than general practices (difference between groups 8.2, 95% confidence interval 1.7 to 14.6) and NHS Direct (10.8, 5.5 to 16.1). There was considerable between scenario variation, with walk-in centres performing particularly well on postcoital contraception and asthma scenarios. In contrast to general practices, walk-in centres and NHS Direct referred a higher proportion of patients (26% and 82%, respectively). CONCLUSION: Walk-in centres perform adequately and safely compared with general practices and NHS Direct for the range of conditions under study, but the impact of referrals on workload of other healthcare providers requires further research.

Adult↗
PubMed2002

Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.

OBJECTIVE: To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting. DESIGN: Systematic review of randomised controlled trials and prospective observational studies. DATA SOURCES: Cochrane controlled trials register, specialist register of trials maintained by Cochrane Effective Practice and Organisation of Care Group, Medline, Embase, CINAHL, science citation index, database of abstracts of reviews of effectiveness, national research register, hand searches, and published bibliographies. INCLUDED STUDIES: Randomised controlled trials and prospective observational studies comparing nurse practitioners and doctors providing care at first point of contact for patients with undifferentiated health problems in a primary care setting and providing data on one or more of the following outcomes: patient satisfaction, health status, costs, and process of care. RESULTS: 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations. CONCLUSION: Increasing availability of nurse practitioners in primary care is likely to lead to high levels of patient satisfaction and high quality care.

Clinical Competence↗
PubMed2002

Questionnaire survey of users of NHS walk-in centres: observational study.

BACKGROUND: NHS walk-in centres have recently been established throughout England to improve access to primary health care. AIM: To determine the characteristics and experiences of people consulting NHS walk-in centres compared with general practice. DESIGN OF STUDY: Observational study using questionnaires. SETTING: Thirty-eight walk-in centres and 34 neighbouring general practices. METHOD: People attending randomly selected survey sessions at walk-in centres or neighbouring general practices on a 'same-day' basis were given a self-administered questionnaire. This collected data about socio-demographic characteristics, reasons for consulting, attitudes to continuity, satisfaction, enablement, referrals, and intentions. RESULTS: Walk-in centre visitors were more likely to be owner-occupiers (55% versus 49%; P<0.001), to have further education (25% versus 19%; P = 0.006), and to be white (88% versus 84%; P< 0.001) than general practice visitors. Main reasons for attending a walk-in centre were speed of access and convenience. Walk-in centre visitors were more likely to attend on the first day of illness (28% versus 10%; P<0.001), less likely to expect a prescription (38% versus 70%, P<0.001), and placed less importance on continuity of care (adjusted odds ratio = 0.58; 95% CI = 0.50 to 0.68) than general practice visitors. People were more satisfied with walk-in centres (adjusted mean difference = 6.6%; 95% CI = 5.0% to 8.2%). Enablement scores were slightly higher in general practice (adjusted mean difference = 0.40; 95 % CI = 0.11 to 0. 6). Following the consultation 13% of walk-in centre visitors were referred to general practice, but 32% intended to make an appointment. CONCLUSION: NHS walk-in centres improve access to care, but not necessarily for those people with greatest health needs. People predominantly attend with problems of recent onset as an alternative to existing health providers, and are very satisfied with the care received. These benefits need to be considered in relation to the cost, and in comparison with other ways of improving access to health care.

Adolescent↗
PubMed2002

A randomised controlled trial of clinics in secondary schools for adolescents with asthma.

AIM: To compare a nurse-led clinic in schools versus care in general practice for adolescents with asthma. DESIGN OF STUDY: Randomised controlled trial in four schools; parallel observational study in two schools. SETTING: Six comprehensive schools. METHOD: In the randomised trial, pupils were invited to attend asthma review at a nurse-led clinic either in school, or in general practice. The parallel observational study compared pupils invited to practice care within and outside the randomised trial. Primary outcome measures were attendance for asthma review, symptom control, and quality of life. Secondary outcomes were knowledge, attitudes, inhaler technique, use of steroids, school absence, peak flow rate, preference for future care, health service utilisation, and costs. RESULTS: School clinic pupils were more likely to attend an asthma review than those randomised to practice care (90.8% versus 51.0% overall [P < 0.001, not consistent across schools]). No differences were observed in symptom control (P = 0.42) or quality of life (P = 0.63). Pupils attending school clinics had greater knowledge of asthma (difference = +0.38, 95% CI = 0.19 to 0.56), more positive attitudes (difference = +0.21, 95% CI = 0.05 to 0.36), and better inhaler technique (P < 0.001, not consistent across all schools). No differences were observed in school absence or peak flow rate. A majority (63%) of those who had received care at school preferred this model in future. Median costs of providing care at school and at the practice were 32.10 Pounds and 19.80 Pounds, respectively. No differences were observed between the groups in the observational comparison on any outcome. CONCLUSIONS: The schools asthma clinic increased uptake of asthma reviews. There were improvements in various process measures, but not in clinical outcomes.

Absenteeism↗
PubMedDate not supplied

NHS walk-in centres and the expanding role of primary care nurses.

Forty pilot NHS walk-in centres have opened over the past two years to provide drop-in nurse-led primary care in England without the input of doctors. As such, these centres represent a revolution for nurse-led care in the health service. However, research suggests that there is considerable variation in the degree of autonomy and independence exercised by the nurses in the different centres. This article discusses this variation, the role of walk-in centre nurses and how this might develop in future.

Attitude of Health Personnel↗