Risk maps and three dimensional models: a rejoinder to Misselbrook and Armstrong.
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Communication↗
Biomedical subjects
Steve Iliffe
Publications and source records attributed to Steve Iliffe.
From general practice to primary care: the industrialisation of family medicine in Britain.
Health services are multi-unit enterprises providing multi-component services, and organisationally are equivalent to very large, diversified companies. Although public health services like Britain's National Health service (NHS) are not for-profit enterprises, they may share characteristics of such enterprises, particularly where these characteristics offer methods of cost-containment. Since all health services, however organised, face the same problem of resources being insufficient to meet demand for health care, they exhibit an underlying tendency towards solving problems in health care using mechanisms borrowed from other industries. This paper attempts to answer the question: to what extent has general practice (family medicine) in Britain's NHS adopted industrial modes of organisation from productive (for-profit) industries?
Cost Control↗
Applying community-oriented primary care methods in British general practice: a case study.
BACKGROUND: The '75 and over' assessments built into the 1990 contract for general practice have failed to enthuse primary care teams or make a significant impact on the health of older people. Alternative methods for improving the health of older people living at home are being sought. AIM: To test the feasibility of applying community-oriented primary care methodology to a relatively deprived sub-population of older people in a relatively deprived area. DESIGN OF STUDY: A combination of developmental and triangulation approaches to data analysis. SETTING: Four general practices in an inner London borough. METHOD: A community-oriented primary care approach was used to initiate innovative care for older people, supported financially by the health authority and practically by primary care academics. RESULTS: All four practices identified problems needing attention in the older population, developed different projects focused on particular needs among older people, and tested them in practice. Patient and public involvement were central to the design and implementation processes in only one practice. Innovations were sustained in only one practice, but some were adopted by a primary care group and others extended to a wider group of practices by the health authority. CONCLUSION: A modified community-oriented primary care approach can be used in British general practice, and changes can be promoted that are perceived as valuable by planning bodies. However, this methodology may have more impact at primary care trust level than at practice level.
Aged↗
Factors affecting the shift towards a 'primary care-led' NHS: a qualitative study. National Health Service.
BACKGROUND: Local Health Care Cooperatives (LHCCs) and Primary Care Groups (PCGs) reflect the continuing importance of a shift towards a 'primary care-led NHS' as a health policy goal in England and Scotland. Yet many commentators have concluded that, to date, the extent of the shift has been limited. To assess the ways in which LHCCs and PCGs might develop in the future, it is necessary to understand the progress made in moving towards a primary care-led NHS and the factors that have either encouraged or hindered its development. AIM: To investigate the nature of the barriers to, and the incentives encouraging the shift towards a primary care-led NHS. DESIGN OF STUDY: Qualitative study using semi-structured interviews. SETTING: Purposive sample of key stakeholders in health authorities, trusts, and primary care in four urban health authorities (two in Scotland and two in England). METHOD: The interviews discussed the commissioning types, the nature and scale of shifts that had occurred, the barriers to and the factors promoting the shift, the mechanisms for discussing and monitoring the shifts that were taking place and the likely impact of LHCCs and PCGs in relation to three common conditions: inguinal hernia, stroke, and asthma. RESULTS: Shifts in activity from secondary to primary care were regarded as small, non-strategic, piecemeal, and not direct underpinned by resource shifts. Barriers identified by responders include the immobility of existing resources, concerns in the primary and secondary care sectors about the appropriateness of the shift weak incentives supporting the shift, the perspectives of general practioners involved in commissioning and the absence of co-operation between key stakeholders. CONCLUSION: The development of a primary care-led NHS needs to resolve a fundamental tension at the heart of the policy: those to whom power was devolved were neither equipped nor minded to engineer the strategic resource shifts necessary to underpin a more primary care-based NHS.
Asthma↗
What do we know about hospital at home? Lessons from international experience.
Hospital in the home' or 'hospital at home' services have become popular solutions to the apparent problems of conventional hospital care in many countries. Until recently their evaluation has been limited, and little has been known about their costs and benefits. A systematic review of randomised controlled trials of such services has failed to detect a difference in mortality and readmission rates of patients using hospital in the home, but does suggest that these services are acceptable to patients, although not necessarily to their carers. Important questions about professional roles and workloads in hospital at home services need further investigation. Overall it does not appear that such services produce cost savings, although this may depend greatly on local circumstances. This discussion paper uses the findings of a systematic review of the literature evaluating hospital at home and hospital in the home services to answer questions surrounding the supplementary or substitution status of these services.
Caregivers↗
An exploratory survey into primary care nurses and dementia care.
This article introduces findings from the first phase of a randomized controlled trial of educational interventions in primary care. The focus of the article is the knowledge, attitudes and confidence of primary care nursing staff to the diagnosis and ongoing management of dementia. A total 78 nurses with a mean age of 46.4 years and a mean time since qualification of 23.0 years were recruited in 36 practices in central Scotland and in London. Disciplines represented by this sample were predominantly district nurses, health visitors, practice nurses and community staff nurses. Each practitioner was administered an extensive self-completion questionnaire before the educational interventions were introduced to measure baseline knowledge, confidence and perceived difficulties in dementia care management and attitudes. Results from the quiz indicate lower levels of knowledge about epidemiology and diagnosis, but slightly higher levels about management strategies. Self-reported ratings of confidence were also low and were directly related to ratings of difficulty in identifying dementia and dealing with coexisting behavioural and mental health problems. Lower scores on all domains were recorded for practice nurses than for district nurses or health visitors.
Attitude of Health Personnel↗