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Biomedical subjects

J Raftery

Publications and source records attributed to J Raftery.

At least 73 records · Page 4Linked to original sources
PubMed1993

A controlled trial of home-based acute psychiatric services. II: Treatment patterns and costs.

Treatment records of 94 patients treated in an experimental home-based psychiatric service and 78 control patients in standard care were collected over one year. There was a substantial reduction in in-patient care in the experimental group, both in terms of proportion admitted and duration of admissions, despite similar out-patient and general practice care. The total treatment costs were significantly larger (> 50%) for standard care when controlled for by diagnostic grouping. Costs were further examined by including all specialist psychiatric care, and by excluding patients with primary diagnoses of brain damage or alcoholism. Sensitivity analysis explored the effects of increasing the cost of home visits. The relative cost effectiveness of the experimental service persisted. Clinical and social outcome was similar in control and experimental groups.

Adolescent↗
PubMed1992

Randomised controlled trial of effects of coordinating care for terminally ill cancer patients.

OBJECTIVES: To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector. DESIGN: Randomised controlled trial. SETTING: Inner London health district. PATIENTS: Cancer patients were routinely notified from 1987 to 1990. 554 patients expected to survive less than one year entered the trial and were randomly allocated to a coordination or a control group. INTERVENTION: All patients received routinely available services. Coordination group patients received the assistance of two nurse coordinators, whose role was to ensure that patients received appropriate and well coordinated services, tailored to their individual needs and circumstances. MAIN OUTCOME MEASURES: Patients and carers were interviewed at home on entry to the trial and at intervals until death. Interviews after bereavement were also conducted. Outcome measures included the presence and severity of physical symptoms, psychiatric morbidity, use of and satisfaction with services, and carers' problems. Results from the baseline interview, the interview closest to death, and the interview after bereavement were analysed. RESULTS: Few differences between groups were significant. Coordination group patients were less likely to suffer from vomiting, were more likely to report effective treatment for it, and less likely to be concerned about having an itchy skin. Their carers were more likely to report that in the last week of life the patient had had a cough and had had effective treatment for constipation, and they were less likely to rate the patient's difficulty swallowing as severe or to report effective treatment for anxiety. Coordination group patients were more likely to have seen a chiropodist and their carers were more likely to contact a specialist nurse in a night time emergency. These carers were less likely to feel angry about the death of the patient. CONCLUSIONS: This coordinating service made little difference to patient or family outcomes, perhaps because the service did not have a budget with which it could obtain services or because the professional skills of the nurse-coordinators may have conflicted with the requirements of the coordinating role.

Anxiety↗
PubMed1992

Prescribing at the hospital-general practice interface. I: Hospital outpatient dispensing policies in England.

OBJECTIVE: To describe the outpatient dispensing policies of major acute hospitals in England. DESIGN: Postal questionnaire survey in November 1990. SETTING: All (278) major acute hospitals in England with more than 250 beds, excluding maternity, paediatric, or psychiatric hospitals; nine hospitals declined. PARTICIPANTS: Hospital chief pharmacists. MAIN OUTCOME MEASURES: Current dispensing policy and exceptions to it; when the policy was formed; and who was involved in its formation. RESULTS: Completed questionnaires were received from 200 (72%) of the hospitals approached. The quantities of drugs dispensed to outpatients ranged from zero in 12 hospitals to unlimited amounts in nine; nearly half (92) dispensed a 14 days' supply of drugs. The greater the restriction on outpatient dispensing, the more recently the policy had been introduced (chi 2 for trend = 7.15; df = 1; p less than 0.01). Permissible exceptions to the policy included the consultant's specific request (134 hospitals), difficulty in obtaining drugs in the community (102), urgent need for start of treatment (49), and certain types of patients (41) or drugs or their regimens (104). Groups who were neither represented on the hospital committee concerned with policy formation nor consulted before policy changes included regional health authorities in 122 hospitals, district health authorities in 101 hospitals, and general practitioners in 32 hospitals. CONCLUSIONS: Outpatient dispensing policies varied considerably among the hospitals surveyed, but they seemed to be moving towards greater restrictions on the supply of drugs given to outpatients.

Drug Prescriptions↗
PubMed1992

Prescribing at the hospital-general practice interface. II: Impact of hospital outpatient dispensing policies in England on general practitioners and hospital consultants.

OBJECTIVE: To assess the impact on general practitioners and hospital consultants of hospital outpatient dispensing policies in England. DESIGN: Postal questionnaire and telephone interview survey of general practitioners and hospital consultants in January 1991. SETTING: 94 selected major acute hospitals in England. PARTICIPANTS: 20 general practitioners in the vicinity of each of 94 selected hospitals and eight consultants from each, selected by chief pharmacists. MAIN OUTCOME MEASURES: Proportions of general practitioners unable to assume responsibility for specialist drugs and of consultants wishing to retain responsibility; association between dispensing restrictions and the frequency of general practitioners being asked to prescribe hospital initiated treatments. RESULTS: Completed questionnaires were obtained from 1207 (64%) of 1887 general practitioners and 457 (63%) of 729 consultants. 570 (46%) general practitioners felt unable to take responsibility for certain treatments, principally because of difficulty in detecting side effects (367, 30%), uncertainty about explaining treatment to patients (332, 28%), and difficulty monitoring dosage (294, 24%). Among consultants 328 (72%) wished to retain responsibility, principally because of specialist need for monitoring (93, 20%), urgent need to commence treatment (64, 14%), and specialist need to initiate or stabilise treatment (63, 14%). The more restricted the drug supply to outpatients, the more frequently consultants asked general practitioners to prescribe (p less than 0.01) and complete a short course of treatment initiated by the hospital (p less than 0.001). CONCLUSIONS: Restrictive hospital outpatient dispensing shifts clinical responsibility on to general practitioners. Hospital doctors should be able to retain responsibility for prescribing when the general practitioner is unfamiliar with the drug or there is a specialist need to initiate, stabilise, or monitor treatment.

Attitude of Health Personnel↗
PubMed1991

Cost of schizophrenia in a randomized trial of home-based treatment.

A randomized trial of acute psychiatric care was conducted to compare home-based interventions with standard care. The setting of the study was a comprehensive urban psychiatric service in London. Sixteen of the 172 patients in the study had schizophrenia--11 in standard care (SC) and 5 in community care (CC). Care for patients with schizophrenia was, on average, twice as expensive as care for nonschizophrenic patients. This large and statistically significant difference was mainly the result of increased inpatient care, which averaged 33 days for the schizophrenic group compared to 7.6 days for non-schizophrenic patients. There was a modest increase in general practice and outpatient contacts among the schizophrenic patients compared with nonschizophrenic patients, but surprisingly little use of day hospital facilities. The SC schizophrenic care cost nearly twice as much as CC care, but this was not a statistically significant difference. These results suggest that provision of active community services for schizophrenic patients may lead to overall savings in care costs, mainly by a reduction in inpatient stays.

Ambulatory Care↗
PubMed1990

The mortality of first and second generation Irish immigrants in the U.K.

The Irish have generally been ignored in studies of the health needs of ethnic groups in the U.K. despite being the largest immigrant group and having the highest Standardised Mortality Ratio of all first generation immigrants. Using the OPCS Longitudinal Study, the present paper shows that this excess mortality persists into the second generation Irish in the U.K., regardless of the part of Ireland from which their parents originated or whether one or both parents were Irish. The effects of social class, age, sex, year of entry to the U.K. and period of death are explored, and variations with these factors are found to be complex.

Adolescent↗