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Biomedical subjects

D Wilkin

Publications and source records attributed to D Wilkin.

At least 37 records · Page 2Linked to original sources

Factors that influence general practitioners' choice of hospital when referring patients for elective surgery.

To describe the factors that influence general practitioners' choice of hospital when referring patients for elective surgery in three specialties, a postal questionnaire was distributed in January 1991 to 449 doctors who had referred patients to one of six hospitals in the North Western Regional Health Authority. Responses were received from 260 general practitioners (58%). Of the respondents 95% selected 'local and convenient' as a factor that commonly influenced their choice of hospital for at least one specialty and 65% mentioned this across all three specialties. Seventy four per cent mentioned patient preference as influencing choice for at least one specialty and 57% across all three specialties. Only 32% of doctors mentioned waiting times for appointment across the three specialties and 26% waiting times for surgery across the three specialties. When asked to select the single most important factor 'local and convenient' was selected by 33% of general practitioners for a least one specialty, the general standard of clinical care by 28% and waiting time for appointment by 23%. Patient preference was only selected by 6% of doctors as the most important factor. It is of note that 33% of general practitioners perceived there to be no choice of hospital for at least one specialty and 14% thought this to be the single most important influence on choice for at least one specialty. Approximately half the general practitioners (49%) considered it always or often appropriate to give their patients a choice. Most general practitioners received waiting time information from hospitals in their own health district but fewer received such information from hospitals outside their district.(ABSTRACT TRUNCATED AT 250 WORDS)

Choice Behavior↗

The meaning of information on GP referral rates to hospitals.

Research shows consistently wide variations in all aspects of general medical practice. Extreme variations in rates of referral to hospital have recently been highlighted, but remain largely unexplained. New information systems now make it possible to identify GPs with very high or very low rates of referral so that their behaviour can be reviewed. Before using this information politicians, managers and doctors should give careful thought to what it means and its limitations. The rate of referral provides no indication of the appropriateness of referrals. Any intervention designed to improve the referral mechanism should aim to increase the proportion of people who are appropriately referred to hospital and to reduce the proportion who are inappropriately referred. This is unlikely to be achieved by focusing attention on GPs with high or low rates regardless of how they are made up.

Behavior↗

A comparison of two survey measures of health status.

Health service planning requires information on levels of health and illness in the population. Surveys, such as the British General Household Survey (GHS) rely on self-reports of health, illness and restriction, but interpretation of results is problematic. Multi-item measures such as the Nottingham Health Profile (NHP) tap different aspects of health and allow respondents less freedom to define health and illness. In a survey of 1862 adults, health questions from the GHS and the NHP were used, and the results compared. Responses to GHS questions were associated with NHP scores, but the strength of the associations between the four GHS questions and the six NHP items varied considerably. Reporting a recent restriction was only weakly associated with NHP scores. Associations between GHS questions and NHP scores were weakest for the NHP items measuring emotional reactions, sleep and feelings of social isolation. Reporting good health or no illness in response to GHS questions was no guarantee that respondents experienced no health problems. Those who use health data from the GHS, NHP or similar surveys should look closely at whether such data provide appropriate information for their purposes.

Adolescent↗

Conceptual problems in dependency research.

The problems presented by dependency groups have become a key issue for health care and social policy in all advanced countries. Providers and policy makers have looked to researchers to develop and apply measures of dependency which will provide a basis for rational planning and service provision. Attempts to define and classify dependency are notable by their absence from the empirical literature. This paper offers a general definition of dependency and develops a classification system based on needs for help and the sources of these needs. Existing measures tackle only a very limited range of problems within this matrix. Issues of reciprocity and dimensions of severity are dealt with separately before considering the implications of this discussion for future research.

Activities of Daily Living↗

Explaining variation in general practitioner referrals to hospital.

Reported rates of referral by individual general practitioners to hospitals range from less than 1% of all consultations to more than 20%. Research on variations in rates of referral by general practitioners in the UK is reviewed here. Studies have largely failed to account for variation either in terms of differences in the characteristics of patients or differences in the doctors and their practices. It is argued that this failure arises because most studies do not distinguish between different types of referral or reasons for making a referral. In order to begin to explain variations it is necessary to identify the stages in the complex process of decision making. A theoretical model of the referral decision is advanced, which is intended to provide a framework for further research on the referral process.

Decision Making↗

Variation in general practitioners' referral rates to consultants.

The variation in the number of patients general practitioners refer to hospital is a source of concern because of the costs generated and the implications for quality and quantity of care This paper compares 32 general practitioners with high referral rates with 35 doctors with low referral rates drawn from a study of 201 doctors. The mean referral rate for all 201 doctors was 6.6 per 100 consultations - for those with high referral rates the mean was 11.8 and for those with low referral rates 2.9. Differences between doctors with high and low referral rates with respect to age, sex, social class and diagnostic case mix of patients consulting were small. Doctors with high referral rates referred more patients in all categories. There were also few differences between the two groups with respect to the characteristics of the doctors themselves or their practices. The findings are discussed in the context of proposals to provide general practitioners with information on their own referral rates compared with those of other doctors.

England↗

Patterns of care for the elderly in general practice.

Little is known about the care provided for the elderly by general practitioners. This study is based on data from 89 030 consultations with patients of all ages of which 17 771 were with patients over 65 years of age. It was found that general practitioners carry out more follow-up work with their elderly patients than with their younger patients and they make more home visits and referrals to nursing and social services. However, they do less investigative work with elderly patients and the level of referral to consultants is the same for patients of all ages. Considerable variation was found between doctors in the pattern of care provided for older patients. The proportion of elderly patients on the list of a general practitioner had little effect on his overall workload. The implications of these findings for health service research and planning are discussed.

Adolescent↗

List size and patient contact in general medical practice.

One hundred and ninety nine general practitioners collected data on consultations with patients for a representative sample of recording days. The number of consultations and amount of time spent in patient contact were positively correlated with the number of registered patients (list size), whereas the consultation rate and the amount of time spent with each patient were negatively correlated. These relations, however, were not too strong, and there was considerable variation among doctors, particularly for those with lower list sizes. These findings have implications for issues concerning quality of care and the potential effects of reductions in patient list size.

Appointments and Schedules↗

Area variations in the process of care in urban general practice.

One hundred and eighty three practitioners collected data on 110 000 consultations. Case mix and pattern of care are compared for doctors practising in different urban areas. Inner city areas are compared with outer areas and the most deprived with the most affluent. Case mix varies slightly between areas, but there are no systematic differences in the pattern of care, which is equally variable in different areas. The stereotype of inner city general practice is not confirmed.

Adult↗

Levels of provision and of dependency in residential homes for the elderly: implications for planning.

Two surveys of dependency among elderly residents in local authority homes are reported. Dependency levels are compared in the light of the large difference in the amount of accommodation provided by the two authorities. Dependency levels are shown to be unrelated to level of provision. The authors suggest that this finding contradicts assumptions frequently made in planning institutional provision for the elderly. Reducing the number of places in residential care, providing specialist homes or establishing nursing homes may not therefore have the intended effect of changing the dependency mix in institutional care.

Activities of Daily Living↗

The implications of managing confused and disabled people in non-specialist residential homes for the elderly.

Local Authority residential homes for the elderly are caring for substantial proportions of physically disabled and mentally confused residents in non-specialist settings. The results of an intensive study of six homes caring for varying proportions of disabled and confused residents are summarized. The homes are compared in terms of staff training and attitudes, physical care of residents, social environment, and attitudes of residents. The authors suggest that a "mix" of residents can have advantages over segregation and that most homes can manage around 30% confused residents. If this is to be successful, attention should be given to staffing levels, staff training and the role of health service staff in residential homes.

Aged↗

Changes in behavioural characteristics of elderly populations of local authority homes and long-stay hospital wards, 1976-7.

Behavioural characteristics of the elderly populations of seven local authority residential homes and three long-stay hospital wards were assessed in 1976 and 1977 with the Crichton Royal behavioural rating scale. In 1977 the levels of behavioural problems had increased in the residential homes, but declined in the hospital wards. Differences between the homes had decreased as the overall level of problems increased. The findings suggested that the additional burden of caring for increasing numbers of severely disabled elderly people was affecting the balance of institutional care, and a radical reappraisal of present patterns of care may be necessary to meet their future needs.

Aged↗