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Biomedical subjects

N Bosanquet

Publications and source records attributed to N Bosanquet.

At least 19 recordsLinked to original sources
PubMed1992

Community clinics for leg ulcers and impact on healing.

OBJECTIVE: To evaluate the effectiveness of community clinics for leg ulcers. DESIGN: All patients with leg ulceration were invited to community clinics that offered treatment developed in a hospital research clinic. Patients without serious arterial disease (Doppler ankle/brachial index > 0.8) were treated with a high compression bandage of four layers. SETTING: Six community clinics held in health centres in Riverside District Health Authority supported by the Charing Cross vascular surgical service. PATIENTS: All patients referred to the community services with leg ulceration, irrespective of cause and duration of ulceration. MAIN OUTCOME MEASURES: Time to complete healing by the life table method. RESULTS: 550 ulcerated legs were seen in 475 patients of mean (SD) age 73.8 (11.9) years. There were 477 venous ulcers of median size 4.2 cm2 (range 0.1-117 cm2), 128 being larger than 10 cm2. These ulcers had been present for a median of three months (range one week to 63 years) with 150 present for over one year. Four layer bandaging in the community clinics achieved complete healing in 318 (69%) venous ulcers by 12 weeks and 375 (83%) by 24 weeks. There were 56 patients with an ankle/brachial arterial pressure index < 0.8, indicating arterial disease. The 50 patients with pressure index < 0.8 > 0.5 were treated with reduced compression, and 24 (56%) healed by 12 weeks and 31 (75%) by 24 weeks. The figures for overall healing for all leg ulcers were 351/550 (67%) at 12 weeks and 417/550 (81%) at 24 weeks, compared with only 11/51 (22%) at 12 weeks before the community clinics were set up. CONCLUSIONS: Community clinics for venous ulcers offer an effective means of achieving healing in most patients with leg ulcers.

Aged↗
PubMed1992

Primary health care in London--changes since the Acheson report.

OBJECTIVE: To examine changes in primary care in London in the 11 years since the Acheson report on primary health care in inner London. DESIGN: Analysis of key data from the family health services authority performance indicators and from the Department of Health; study of trends since the time of the Acheson report; examination of the provision of primary care in 1990-1 and its relation to health and social factors. SETTING: Comparisons between the family health services authorities of inner London, outer London, and England as a whole, with a special study of Birmingham, Liverpool, and Manchester. SUBJECTS: The family health services authorities of England. RESULTS: There has been an improvement in the provision of primary care in inner London as judged by the criteria of the Acheson report, but these improvements have occurred only as part of an overall improvement in the provision of primary care in the country as a whole. None of the recommendations of the Acheson report specifically oriented to London have been implemented. There are some worrying trends in inner London, such as the increasing proportion of practices with more than 2500 patients. The problems faced by practitioners in inner London resemble those in other large inner city areas, but the primary care provision to deal with them is relatively poor.

Family Health↗
PubMed1992

Immunization in the UK: policy review and future economic options.

Vaccination is one of the most effective health promotion activities, but specific targets have been difficult and costly to achieve, and have frequently fallen short of the desired aims, leaving some vulnerable groups unprotected. Policy in the UK has differed for the childhood diseases and in some cases, for example diphtheria and poliomyelitis, has been successful in almost eliminating the disease. In other cases, such as that of pertussis, there has been public opposition, and for other diseases, for example, measles, sufficient numbers of the susceptible population have only recently been reached. Although the World Health Organization target of 90% uptake for the childhood diseases has been reached for all except pertussis, the figures conceal lower uptake rates in some areas, particularly the inner cities. The introduction of target payments to general practitioners appears to have had some effect in increasing uptake rates, particularly in some inner city areas, although the change in immunization schedules may also have had an impact. Target payments fail to take account of the difficulties faced by inner city GPs and, in effect, favour those who need to make least effort, since, in some areas, high uptake rates may already have been achieved before targets were introduced. It is suggested that there is a case for special local development programmes in inner city areas which will provide help with improving record keeping and recall systems for immunization. An alternative policy, which might be more difficult to implement, would be to have targets which could be set at different levels in different areas so that uptake rates could be progressively improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Practice↗
PubMed1992

The budgetary impact of 5-HT3 receptor antagonists in the management of chemotherapy-induced emesis.

The study examined the budgetary implications of using 5-hydroxytryptamine3 receptor antagonists (5-HT3RA), granisetron or ondansetron, in the management of chemotherapy-induced emesis (CIE). A treatment model was constructed to represent a baseline of efficacy and costs for treating a cohort of patients with conventional antiemetics. Groups of patients who would be expected to receive the most benefit from 5-HT3RA were then identified and the effect upon costs of using these compounds in a consecutively larger proportion of selected patients was calculated. On the basis of illustrative costs from The Cookridge Hospital in the UK, it was concluded that the new antiemetics can be used in acute emesis with substantial clinical benefit for an increase of 3-10% to total treatment costs. However, for delayed emesis these compounds have not yet shown a clinical advantage, and the increase in total costs of 12-34% is not justified.

Antiemetics↗
PubMed1991

Smoking and economic incentives in Europe.

This paper reviews the agenda for economic research near the beginning of a formative period for policy marked by much greater involvement by the EC (European Community). There are few signs as yet of any diffusion process at work in Europe to bring about reductions in smoking. Effective use of incentives will be needed to bring about reductions in smoking by 2000 and to stop yet further massive increases in mortality from smoking related disease. Research is needed on price and income elasticities in Europe as the EC introduces new policies for raising cigarette taxes and prices. Currently most estimates are based on US and UK data. There is also an important research agenda on the decision-making process in Europe covering the policy response of national governments and professions as well as the future role of the EC Commission. Finally, research is needed on the micro-economic determinants of the demand for tobacco products across Europe by households. Household data from family expenditure surveys are now available across Europe so that it is now possible to construct micro demand systems for each European country.

Cross-Sectional Studies↗
PubMed1989

High and low incomes in general practice.

The Review Body on Doctors' and Dentists' Remuneration deals with average incomes and costs, and little evidence is available on local variability. In a study on general practice the distribution of high and low incomes was assessed. High income practices (defined as those with net incomes per partner of more than 35,000 pounds a year) were more likely to be larger, to have younger partners, and to be located in affluent areas. Low income practices (with a net income of less than 20,000 pounds per partner) were smaller, located in more urban areas, and more likely to have Asian partners. High income practices had higher costs per patient and more staff resources. Low income practices had fewer practice resources and faced great disincentives to investment. These practices were concentrated in less affluent areas, where the need for improved organisation of practices is greatest. General practice is becoming increasingly divided between high income, high cost practices and those with low incomes and few resources.

England↗
PubMed1988

Uptake of immunisation in district health authorities in England.

The uptakes of immunisation in the district health authorities in England were studied for the years 1983-5. Multiple regression analysis showed that the factors significantly associated with a low uptake of immunisation were mainly related to social conditions, particularly overcrowding of households and population density. Of the service factors, high proportions of elderly and singlehanded general practitioners and high average list sizes were also associated with a low uptake of immunisation in some of the analyses. The results suggest that the measures outlined in the government's white paper on improving primary health care services are likely to lead to improved uptakes of immunisation. If, however, the uptakes of immunisation are used as a measure of standards of the services provided they should first be adjusted to control for variations in social conditions, and the quality of vaccination data would have to be improved.

Child↗
PubMed1988

Family doctors and innovation in general practice.

Family doctors have been presented with changes in government policies and incentives in a recent white paper on primary care. Little work has been done, however, to find out how general practitioners respond to such measures. The response of general practitioners to professional and economic incentives was examined in relation to the location of the practice and the characteristics of the practitioners in seven different areas of England. The areas represented urban, rural, affluent, and deprived communities. The overall response rate was 74%, but the response varied among the areas, being poorest (64%) in an inner city area. Practices were subdivided as innovative, traditional, or intermediate, according to whether they employed a nurse and participated in the cost rent scheme and the vocational training scheme. Innovative practices were defined as fulfilling two of these criteria and traditional practices as fulfilling none; the remainder were classed as intermediate. The results showed that these three types of practice had distinct strategies that were related to financial constraints and the local population. Innovative practices had more partners and were often located in rural or affluent suburban areas; traditional practices had fewer partners and were more common in urban and working class areas. Innovative practices seemed to be in the best position to increase their services, and hence their incomes, in response to the recent proposals in the white paper. Practices in areas of developmental difficulty (predominantly urban but not necessarily inner city areas) had been less able to respond to existing incentives and had a smaller margin available for developing their services. In view of the effect of local constraints of economics and population on the strategy of practices, concentrating resources for primary care in local budgets for working class and urban areas may be preferable to extending the system of charging fees for services provided by family doctors.

Family Practice↗
PubMed1987

Nursing manpower.

Explore the source record for details and available documents.

Education, Nursing↗
PubMed1986

Family doctors: their choice of practice strategy.

The economic decisions taken by family doctors in one family practitioner area in the north of England were examined. There was evidence of a differential response to professional and economic incentives by a group of "high investing" practices. On five indicators of improvement in practice 32% of the practices accounted for 71% of the positive scores. Nearly all the high investing practices were in affluent areas; they were on average larger and had younger partners than the other practices. The high investing practices also faced more financial problems. There was evidence that older doctors with long lists of patients had a different strategy of income maximization. Innovation in primary care is not determined by attitude alone but also by objective factors such as age, location, and size of the practice.

England↗
PubMed1986

Ways of influencing the behaviour of general practitioners.

What evidence is there for the success or failure of the different methods used to influence the behaviour of general practitioners, whether in their work with patients, or in the organization of a practice?This preliminary exploration of the literature suggests that, although change is always occurring, its deliberate inducement is usually slow and laborious. Doubt is cast on the efficacy of existing financial incentives, and of unsolicited feedback about performance. There is little evidence for the influence of audit on behaviour but personal contact with doctors, nurses and other colleagues, and to a lesser extent with patients, is relatively effective, both in influencing the teamwork of a practice and in more formal education. However, it is combinations of different methods which most successfully influence general practitioners.

Behavior↗