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Biomedical subjects

M Calnan

Publications and source records attributed to M Calnan.

At least 37 records · Page 2Linked to original sources
PubMed1998

Health promotion. Beating the bands?

A survey of health authorities in England to establish GPs' health promotion activities found that anti-smoking and heart disease prevention were the most common initiatives. Many HAs were dissatisfied with the current arrangements, feeling that they had little control of GPs' health promotion activities. Two-thirds of HAs reported problems with monitoring GPs' health promotion activities. Few health promotion initiatives addressed mental health, cancer or accident prevention.

Family Practice↗
PubMed1998

Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors.

OBJECTIVES: To explore the circumstances and factors that explain variations in response to a cardiac event and to identify potentially modifiable factors. DESIGN: Qualitative analysis of semistructured, face to face interviews with patients admitted to two district hospitals for a cardiac event and with other people present at the time of the event. Patients were divided into three groups according to the length of delay between onset of symptoms and calling for medical help. SUBJECTS: 43 patients and 21 other people present at the time of the cardiac event. Patients were divided into three groups according to the length of time between onset of symptoms and seeking medical help: non-delayers (< 4 h; n = 21), delayers (4-12 h; n = 12), and extended delayers (> 12 h; n = 10). MAIN OUTCOME MEASURES: Decision making process, strategies for dealing with symptoms, and perception of risk and of heart attacks before the event according to delay in seeking help. RESULTS: The illness and help seeking behaviour of informants had several components, including warning, interpretation, preliminary action, re-evaluation, and final action stages. The length of each stage was variable and depended on the extent to which informants mobilised and integrated resources into a strategy to bring their symptoms under control. There were obvious differences in informants' knowledge of the symptoms that they associated with a heart attack before the event. Non-delayers described a wider range of symptoms before their heart attack and twice as many (13) considered themselves to be potentially at risk of a heart attack compared with the other two groups. For most informants the heart attack differed considerably from their concept of a heart attack. CONCLUSION: The most critical factor influencing the time between onset of symptoms and calling for professional medical help is that patients and others recognise their symptoms as cardiac in origin. This study suggests that various points of intervention in the decision making process could assist symptom recognition and therefore faster access to effective treatment.

Age Factors↗
PubMed1998

Managerialism and active citizenship in Britain's reformed health service: power and community in an era of decentralisation.

The creation of a large managerial stratum within the British National Health Service in recent years has been one of the most striking characteristics of reforms intended to develop a more efficient and "business-like" service. An accompanying political rhetoric of decentralisation has cast local managerial autonomy as a means to gauge and respond more easily to the needs and preferences expressed by local communities. This article therefore reviews the growth of the new managerial stratum with particular regard to its emerging relationship with the local populations in whose name the organisational reforms have been wrought. The dominant political interpretation of this relationship--that the organisational reforms constitute a movement from leaden "bureaucratic" administration to more locally accountable and responsive managerial regimes--is then tested with regard to an in-depth study of two health authorities responsible for very different local populations. Results show that the role of local populations in influencing decisions and determining priorities is considerably less than inferred by the sustained political rhetoric in favour of the "local voices". Consideration of possible trends in the state and economy suggests however that this disjuncture may not be explicable solely in terms of the new managerial stratum maximising its influence or of central government retaining a high degree of control.

Community Health Services↗
PubMed1997

Implementing quality: a study of the adoption and implementation of quality standards in the contracting process in a general practitioner multifund.

The increase in managerialism in the 1980s and the 1990 NHS reforms have had major implications for the regulation of providers. Purchasers of health care in the UK are now expected to specify three factors in their contracts: volume, cost and quality. This paper focuses on one of these: i.e. the quality standards purchasers now include within their health service contracts. The case study is of a general practitioner multifund and the analysis focuses on how quality standards are derived and adopted in outpatient contracts. The data were derived from in-depth face-to-face interviews with the key participants in the contracting process. The evidence shows that the standards were derived and adopted with very little participation from the providers. The impact of the quality standards on hospitals consultants' behaviour was negligible, there was very little monitoring of the standards by the multifund, and providers accepted standards which they knew they could not meet. It is concluded that this non-participatory method of developing the quality standards is likely to mean that their impact on service delivery will be limited.

Ambulatory Care↗
PubMed1996

The 'limits' of medicalization?: modern medicine and the lay populace in 'late' modernity.

Taking as its point of departure the medicalization thesis and its limitations, this paper provides a critical discussion of certain more recent theoretical perspectives on life in contemporary society, and their relevance for understanding the relationship between modern medicine and the lay populace. In particular, attention is paid to the contours and existential parameters of life in 'late' modernity in terms of the following four key themes: (i) modernity as a 'reflexive' social order, (ii) 'risk' and the dialectic of scientific and social rationality; (iii) the "mediation' of contemporary experience; and (iv) lay 're-skilling' and the 'life political' agenda. On the basis of this, it is argued that far from being simply passive and dependent, a 'critical distance' is beginning to emerge between modern medicine and the lay populace; a situation which resonates with broader social trends and currents within society at large.

Aged↗
PubMed1995

The role of the general practitioner in health promotion in the UK: the case of coronary heart disease prevention.

This paper examines the approach taken to health promotion and disease prevention in primary care in the UK, using coronary heart disease prevention (CHD) as an illustration. The paper considers the approach taken by the UK's government, the level of involvement of general practitioners (GP) and community nurses in CHD prevention, the factors that influence variation in involvement and the evidence for effectiveness.

Community Health Nursing↗
PubMed1995

Citizens' views on health care.

Considers the importance and relevance of taking into account the views of the public in the provision of health care. Identifies the salient questions and explores some of the broader issues. Aims to describe how far countries have been concerned to take into account citizens' views, the mechanisms and channels through which these views are represented and their effectiveness for influencing decision making.

Community Participation↗
PubMed1995

Why do people go to their doctors?

The evidence presented here suggests for most people deciding to consult a doctor is not a common event and that they have 'good' reasons for consulting, when they do, which are tied up with their own personal and social circumstances. Their evaluation of the care they receive will be tied to how far their specific problems and associated needs are met.

England↗
PubMed1995

Challenges to professional autonomy in the United Kingdom? The perceptions of general practitioners.

Theoretical analysis has suggested that so-called threats to professional autonomy in the United States might also be manifesting themselves in the United Kingdom through the introduction of market principles and the new "managerialism" into the National Health Service by the government and through the emergence of complementary medicine and the role of the "articulate" consumer. The authors explore these issues by focusing on how a sample of the "rank and file" of general practitioners perceive these potential challenges from "above and below." The evidence suggests that the social, economic, and clinical freedoms of general practitioners remain intact although these external influences appear to have changed the style of clinical practice, which is a source of concern and dissatisfaction to some general practitioners.

Adult↗
PubMed1994

A spoonful of sugar helps the medicine go down? Perspectives on the use of sugar in children's medicines.

This analysis examines the policy issues involved in the removal of sugar from paediatric medicines. It reports a study which investigates the perspectives of professionals, consumers, and the pharmaceutical industry. Interviews were conducted with: parents of children receiving long term medication, dental professionals involved in influencing policy or caring for such children, and drug companies who produce medication for long term use by children. Results showed that the parent group preferred the tablet over the liquid form of medication; this was also considered acceptable by the key dental professionals interviewed. The removal of sugar from liquid medicine (rather than the alternative use of smaller tablets) was not therefore a policy generally preferred by the groups involved in the issue. It was concluded that the singular concern of the dentist, doctors and pharmacists to remove sugar from liquid paediatric medicines was a reflection of their altruistic intentions. The limited biomedical perspective of clinically trained occupations prevented them from exploring the wider issues of the various needs of consumers. Thus, the analysis highlights the problems which have been introduced by professional dominance in the issue of medication caries.

Attitude of Health Personnel↗
PubMed1994

Major determinants of consumer satisfaction with primary care in different health systems.

It is becoming increasingly recognized that patient or 'consumer' views should be taken into account as part of a comprehensive assessment of quality of care. This paper reports a study carried out in four European countries about consumer satisfaction with primary care. The results showed that higher levels of general satisfaction with general practitioner services were found in Canterbury (95%) and Ioannina (87%) than Belgrade (85%) and Moscow (62%). Further analysis of the data showed that in all four cities the key dimensions of satisfaction with general practitioner care are both the nature in quality of the doctor-patient relationship and the GP's professional skills. The implications of these findings are discussed.

Adolescent↗
PubMed1994

Involvement of the primary health care team in coronary heart disease prevention.

BACKGROUND: Recent years have seen a vast increase in the amount of health promotion activity undertaken in general practice. AIM: This study set out to identify the level of general practitioner and nurse involvement in activities aimed at coronary heart disease prevention and to examine variations in involvement. METHOD: A questionnaire survey was undertaken of a sample of general practitioners across England and the nurses who worked in their practices. RESULTS: Of 1696 randomly selected general practitioners 64% completed a questionnaire, of 928 practice nurses 71% responded and of 682 health visitors and 679 district nurses 52% and 40% responded, respectively. Of the general practitioners 94% reported that they were involved in assessing lifestyle risk factors in the routine consultation and regular assessments most commonly involved blood pressure testing and inquiry about smoking status. Eighty six per cent of practices were reported by the practice nurse as having well person clinics; these clinics were usually run by the practice nurse. Clinics for the management of specific lifestyle risk factors were also usually run by practice nurses, although many doctors were involved in hypertension clinics and cholesterol clinics. Health visitors and district nurses had a low level of involvement in this practice based clinic activity. Involvement of general practitioners and practice nurses in coronary heart disease prevention was associated with training in health promotion and positive attitudes towards prevention and health promotion. The level of involvement of practice nurses in health promotion was associated with the support received from primary health care facilitators, family health services authorities and district health authorities. CONCLUSION: Members of the primary health care team appeared to have their own distinct area of preventive activity. However, this division did not appear to be a result of organized teamwork and deployment of skills and expertise according to a clearly defined management protocol. Instead it seemed to be a product of general practitioner contract and management arrangements which tended to encourage an approach to general practice health promotion which revolved around the practice nurse and which hindered the development of a broader team based approach to planning and delivery of health promotion in relation to the needs of the practice population.

Coronary Disease↗
PubMed1993

Reach for the sky.

Amputee patients should aspire to higher levels of service from limb fitting centres, say Michael and Janet Limb and Michael Calnan.

Artificial Limbs↗
PubMed1993

Pacemaker.

Explore the source record for details and available documents.

Coronary Disease↗
PubMed1993

Coronary heart disease prevention: the role of the general practitioner.

The objectives of the study were to identify the level of general practitioner (GP) involvement in activities aimed at coronary heart disease prevention and to explain variations in involvement. These questions were explored through a postal survey of a random sample (n = 1696) of GPs in England of whom 64% completed questionnaires. Ninety-four per cent of GPs reported that they were involved in risk factor assessment in the consultation although these assessments most commonly involved blood pressure testing and identification of smoking. Ninety-one per cent of practices were reported by the GP to have a lifestyle risk assessment clinic where there was more evidence of systematic risk assessment. These clinics were usually run by a practice nurse as were lifestyle risk factor management clinics although GPs were more involved in hypertension and cholesterol clinics. Positive attitudes to prevention and training in health promotion were associated with higher GP involvement, and higher practice involvement was associated primarily with the number of practice nurses employed. The implication of these findings are discussed.

Adult↗