Tobacco funding for academics. A public relations disaster.
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Humans↗
Biomedical subjects
S M McGhee
Publications and source records attributed to S M McGhee.
Shared care in diabetes.
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Diabetes Mellitus↗
Delivery of care for hypertension.
To overcome shortcomings in the delivery of care for hypertension various approaches have been developed including a system whereby care of hypertension is shared in a formal manner between general practitioners and hospital specialists. The feasibility, acceptability and cost-effectiveness of a computerised model of shared care were investigated in three matched groups of patients attending hypertension clinics in Glasgow. Glasgow Blood Pressure Clinic attenders considered suitable for shared care by their consultants were randomised to shared care (n = 277) or continued clinic follow-up; a further control group (n = 277) was identified from an independent nurse-practitioner clinic. After 2 years of follow-up, feasibility was estimated by the proportion of patients who had undergone an adequate review (blood pressure, serum creatinine and electrocardiograph); acceptability to general practitioners and patients was assessed by questionnaires; cost-effectiveness was calculated as the cost (to National Health Service and patient) per adequate review. The drop-out rate for shared care over 2 years was 3% compared with 14% for the outpatient clinic and 9% for the nurse-practitioner clinic. In year 2, rates of adequate reviews were 82%, 52% and 75%, respectively. Blood pressure control was similar in the groups. Of 297 general practitioners invited to participate, 85% agreed and 68% wished to continue participation after 2 years. About 50% of shared care patients preferred this method of follow-up compared with their earlier experience of clinic attendance. Shared care was more cost-effective than either conventional or nurse-practitioner clinic follow-up, especially with respect to cost to the patient; costs per adequate review (pound sterling) were 28.96, 50.55 and 30.95, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Delivery of Health Care↗
Coordinating and standardizing long-term care: evaluation of the west of Scotland shared-care scheme for hypertension.
BACKGROUND: The long-term management of patients with chronic conditions such as hypertension presents problems for the health services. Shared care addresses these by coordinating care and defining responsibilities. AIM: This study set out to investigate the feasibility, acceptability and cost effectiveness of shared general practitioner-hospital care for well-controlled hypertensive patients in an urban area by comparing three matched groups of patients. METHOD: A total of 554 outpatient clinic attenders, considered suitable for shared care by their consultant, were randomly allocated to shared care or follow up in the outpatient clinic; a third group of 277 patients was selected from a nurse practitioner clinic. Main outcome measures were the proportion of patients in the second year of follow up who had undergone a complete review (blood pressure measurement, serum creatinine level result and electrocardiograph report), acceptability to patients and general practitioners as assessed by questionnaire, and cost per complete review in year two (National Health Service and patient costs). RESULTS: After two years 220 (82%) shared care patients had had a complete review compared with 146 (54%) outpatient clinic attenders and 202 (75%) nurse practitioner clinic attenders. Blood pressure control was similar in each group. Of 297 general practitioners invited, 85% wished to participate in the study; 61% of questionnaire respondents subsequently wanted shared care to continue while 25% were unsure. Half of the patients receiving shared care preferred this method of follow up. The rank order of cost-effectiveness ratios was shared care, nurse practitioner care and conventional outpatient care, relative differences being most marked when only patient costs were considered. CONCLUSION: Shared care for hypertension is feasible in an urban setting, acceptable to the majority of participants and is a cost-effective method of long-term follow up.
Chronic Disease↗
Incidence of and mortality from cancer in hypertensive patients.
OBJECTIVES: To assess incidence of and mortality from cancer in hypertensive patients taking atenolol, comparing the findings with two control populations and with hypertensive patients taking other drugs. DESIGN: Retrospective analysis of patients first seen in the Glasgow Blood Pressure Clinic between 1972 and 1990. Patients' records were linked with the registrar general's data for information on mortality and with the West of Scotland Cancer Registry for information on incident and fatal cancers. Cancers were compared in patients and controls and in patients taking atenolol, beta blockers other than atenolol, and hypotensive drugs other than beta blockers. SUBJECTS: 6528 male and female patients providing 54,355 years of follow up. SETTING: Hypertension clinic in Glasgow. MAIN OUTCOME MEASURES: Observed numbers of cancers in clinic patients were compared with expected numbers derived from cancer rates in two control populations adjusted for age, sex, and time period of data collection. RESULTS: Cancer mortality was not significantly different in clinic patients as a whole and controls. Incident and fatal cancers were not significantly increased in male or female patients taking atenolol. Cancer incidence did not rise in the clinic after a large increase in prescriptions for atenolol after 1976. CONCLUSION: This analysis does not suggest a link between atenolol and cancer.
Age Factors↗
Patient knowledge about diuretic prescription.
1. In order to assess the prevalence and knowledge of diuretic prescription, 203 consecutive admissions to three general medical wards were interviewed. Additional information was collected on forms sent to general practitioners and hospital doctors responsible for each patient. 2. Prevalence of diuretic use was 31% (63 patients); other drugs only, 60% (121 patients); no drugs, 9% (19 patients). Patients gave an incorrect indication for 31% of diuretics prescribed, but for only 16% of other drugs (P < 0.005). 3. Compared with patients not taking diuretics, diuretic-users were older (mean +/- s.d., 70 years +/- 14 vs 54 +/- 20, P < 0.001), had lower abbreviated mental test scores (AMT scores seven or less, 21% vs 9%, chi 2 = 3.48, P = 0.06) and were prescribed more drugs (5.0 +/- 2.4 vs 3.2 +/- 2.0, P < 0.001). Increasing age and decreasing AMT score were associated with poorer knowledge of drug indication, but these factors could not explain fully the poor understanding of diuretic prescription. 4. Accurate recall of dose was the same for diuretics and for other agents. Knowledge about medication was not different if the general practitioner or hospital initiated treatment.
Adolescent↗
Patients' attitudes to participation in clinical trials.
1. In order to assess attitudes of patients to participation in therapeutic trials 197 patients underwent structured interviews conducted by a single observer. Of these patients 66 were previous or current participants in clinical trials (group A), 12 had declined participation in a trial (group B), and 119 had never been invited to participate in research (group C). 2. In group A, 62% stated their motivation for participation was to help others and 39% to improve their own treatment, but in 38% participation was to comply with the doctor's request. Two-thirds of group C patients would or might participate in a future hypothetical trial; of these more than half (57%) would do so to help others, and 42% to improve their own treatment. 3. Of the 12 patients who had declined entry into a study (group B) three did not want to alter their current therapy, three had insufficient time to participate in the particular trial, and in three cases relatives objected to their participation. Group C patients who stated they would not participate in trials gave being too ill (22%), not wanting to change treatment (22%), and fear of side-effects (17%) as the commonest reasons for declining. 4. In group A, 83% felt they had adequate time to consider their participation. Nearly two-thirds of patients (60%) would have liked written information to retain for reference, whereas only 38% were provided with information in this form. Over half of these patients (54%) disliked no aspect of the study in which they participated. Venepuncture and other uncomfortable procedures were least popular.(ABSTRACT TRUNCATED AT 250 WORDS)
Attitude to Health↗
Treatment of hyperthyroidism by radioactive iodine. Summary of a UK national survey prepared for the Royal College of Physicians Committee on Endocrinology and Diabetes.
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Aftercare↗
Patient on-line access to medical records in general practice.
Many patients want more information about health and the computer offers tremendous potential for interactive patient education. However, patient education and the provision of information to patients will be most effective if it can be tailored to the individual patient by linkage to the medical record. Furthermore the Data Protection Act requires that patients can have access to explained versions of their computer-held medical record. We have examined the practicality and possible benefits of giving patients on-line access to their medical records in general practice. Seventy patients (20 males; 50 females) took part in the study. Sixty five of these used the computer to obtain information. The section on medical history was most popular, with 52 people accessing it. More than one in four of the problems were not understood until the further explanation screen had been seen. One in four also queried items or thought that something was incorrect. Most patients obviously enjoyed the opportunity to use the computer to see their own medical record and talk to the researcher. Many patients commented that because the General Practitioner (GP) didn't have enough time, the computer would be useful. Sixty one (87%) (95% CI: 79-95%) thought the computer easy to use and 59 (84%) would use it again. This is despite the fact that 43 (61%) thought they obtained enough information from their GP. This small study has shown that patients find this computer interface easy to use, and would use the computer to look at explanations of their medical record if it was routinely available.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Medical records: practicalities and principles of patient possession.
This review of issues and research is in two parts: 1) practical problems surrounding patient-held records and 2) ethical arguments for and against patient-held records. We argue that research on patient-held records indicates that there are no substantial practical drawbacks and considerable ethical benefits to be derived from giving patients custody of their medical records.
Comprehension↗
Appropriateness of hospital referral for hypertension.
OBJECTIVE: To examine the efficiency of referral to an outpatient clinic and particularly the differences between referrals from general practitioners practising in health centres and those from other general practitioners. DESIGN: Retrospective audit of referral letters and case notes by comparison with externally set standards of appropriateness of referrals over two years. SETTING: Outpatient hypertension clinic at Western Infirmary, Glasgow. PATIENTS: 306 Consecutive new referrals of patients over two years (1 May 1986 to 30 April 1988), for whom case notes were available in 298. MAIN OUTCOME MEASURES: Congruence of referrals with each of two standards of appropriateness based on published opinion on specialist referral (standard 1 was stricter than standard 2) and completeness of referral letters. RESULTS: Of the 298 referrals, those from general practitioners accounted for 205, from other hospital departments 68, and from other sources 25. Overall, 84 referrals of the 205 from general practice met the first standard and 134 met the second, more lenient standard. 58 Referral letters from outside the hospital had some item missing. Referrals from general practitioners working in health centres (a fifth of the total) were significantly more likely to meet both standards (p less than 0.01) and to send a complete referral letter (p less than 0.001) than the 145 referred by other general practitioners. CONCLUSIONS: According to the standards used, general practitioners in health centres made more appropriate referrals, and further investigation is needed to identify the underlying factors responsible.
Ambulatory Care↗