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Biomedical subjects

David A Richards

Publications and source records attributed to David A Richards.

22 records · Page 2Linked to original sources
PubMed2002

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs.

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. PARTICIPANTS: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference pound 1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments.

Appointments and Schedules↗
PubMedDate not supplied

Developing a U.K. protocol for collaborative care: a qualitative study.

OBJECTIVE: This study aimed to explore the views of stakeholders including patients, general practitioners (GPs) and mental health workers on the feasibility, acceptability and barriers to a collaborative care model for treatment of depression within the context of U.K. primary health care. METHOD: We used semistructured interviews and focus groups with a purposive sample of 11 patients and 38 professionals from a wide selection of primary and secondary care mental health services, as well as framework analysis using a "constant comparative" approach to identify key concepts and themes. RESULTS: Regular contact for patients with depression is acceptable and valued by both patients and professionals. However, patients value support, whereas professionals focus on information. To be acceptable to patients, contacts about medication or psychosocial support must minimize the potential for patient disempowerment. The use of the telephone is convenient and lends anonymity, but established mental health workers think it will impair their judgments. While patients merely identified the need for skilled case managers, GPs preferred established professionals; however, these workers did not see themselves in this role. All involved were cautious about deploying new workers. Additional barriers included practical and organizational issues. CONCLUSIONS: Although a telephone-delivered mix of medication support and low-intensity psychological intervention is generally acceptable, significant issues to be addressed include the values of the current mental health workforce, fears about new workers' experience and competence, the balance of face-to-face and telephone contacts and case manager education in nonspecific skills necessary to develop a therapeutic alliance, as well as the knowledge and skills required for education, medication support and behavioral activation. Qualitative research can add value to careful modeling of collaborative care prior to international implementation.

Attitude of Health Personnel↗
PubMedDate not supplied

Monitoring synaptic vesicle recycling in frog motor nerve terminals with FM dyes.

Ultrastructural observations made in the study of the frog neuromuscular junction (NMJ) almost three decades ago showed that synaptic vesicle cycling functions through a slow pathway, requiring the use of clathrin-coated vesicles and an endosomal compartment. Simultaneously, a conceptually simpler model emerged, postulating rapid retrieval of vesicle membrane through a mechanism similar to a reversal of vesicle fusion. With the advent of fluorescence imaging which allows the investigator to monitor recycling in living nerve-muscle preparations, new data appeared which reconcile at least in part the two models, indicating that both may be important at this synapse. Two different synaptic vesicle pools can be defined, a readily releasable pool (RRP), consisting of quanta that are immediately available for release, and a reserve pool (RP) that is exocytosed only after prolonged stimulation. Vesicles in the RRP recycle through a fast endocytic pathway, which does not rely on an endosomal compartment, while vesicles in the RP cycle more slowly through formation of infoldings and endosomes and their subsequent severance into vesicles. The two pools mix slowly, and their recycling may be regulated by different mechanisms.

Animals↗