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Biomedical subjects

Tom Fahey

Publications and source records attributed to Tom Fahey.

47 records · Page 3Linked to original sources
PubMed2003

Quality measurement of care for people with type 2 diabetes in Tayside, Scotland: implications for the new UK general practice contract.

BACKGROUND: The new United Kingdom general practice contract proposes that up to a third of general practitioners' income will come from achieving quality targets. AIM: To examine selected quality markers in terms of their robustness to case-mix variation and chance effects, and in the attribution of quality to practices. STUDY DESIGN AND METHODS: Data were extracted from a population-based diabetes clinical information system in Tayside, Scotland, for patients with type 2 diabetes registered in 67 practices with complete ascertainment. RESULTS: Most practices would have received relatively high levels of payment for the process measures examined. Outcome measures appeared more challenging. Case-mix adjustment for age, sex, and postcode-assigned deprivation altered measured performance by up to 7%, but payment by up to 14%. Despite no strong evidence of any real difference in quality, chance effects meant that there was greater apparent variability for smaller practices from year to year. Hospital attendance was common, but highly variable between practices. CONCLUSION: Case-mix adjustment to allow fairer comparison is routine in national performance indicators, and ignoring it risks making the new contract quality framework inequitable. Because of chance effects, smaller practices may have greater year-to-year variability in income. Reflecting National Health Service structure, the new contract provides no incentives for integrated care and offers a perverse incentive to refer more patients to hospital. There are trade-offs between the validity of measures, and the cost and bureaucracy of collecting data. The planned evaluation of the new contrast should examine the effectiveness and equity of the quality framework, and rapidly act on deficiencies found.

Diabetes Mellitus, Type 2↗
PubMed2002

Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference.

BACKGROUND: Checklists for peer review aim to guide referees when assessing the quality of papers, but little evidence exists on the extent to which referees agree when evaluating the same paper. The aim of this study was to investigate agreement on dimensions of a checklist between two referees when evaluating abstracts submitted for a primary care conference. METHODS: Anonymised abstracts were scored using a structured assessment comprising seven categories. Between one (poor) and four (excellent) marks were awarded for each category, giving a maximum possible score of 28 marks. Every abstract was assessed independently by two referees and agreement measured using intraclass correlation coefficients. Mean total scores of abstracts accepted and rejected for the meeting were compared using an unpaired t test. RESULTS: Of 52 abstracts, agreement between reviewers was greater for three components relating to study design (adjusted intraclass correlation coefficients 0.40 to 0.45) compared to four components relating to more subjective elements such as the importance of the study and likelihood of provoking discussion (0.01 to 0.25). Mean score for accepted abstracts was significantly greater than those that were rejected (17.4 versus 14.6, 95% CI for difference 1.3 to 4.1, p = 0.0003). CONCLUSIONS: The findings suggest that inclusion of subjective components in a review checklist may result in greater disagreement between reviewers. However in terms of overall quality scores, abstracts accepted for the meeting were rated significantly higher than those that were rejected.

Abstracting and Indexing↗
PubMed2002

Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults.

OBJECTIVES: To determine whether over the counter cough medicines are effective for acute cough in adults. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: Search of the Cochrane Acute Respiratory Infections Group specialised register, Cochrane Controlled Trials Register, Medline, Embase, and the UK Department of Health National Research Register in all languages. INCLUDED STUDIES: All randomised controlled trials that compared oral over the counter cough preparations with placebo in adults with acute cough due to upper respiratory tract infection in ambulatory settings and that had cough symptoms as an outcome. RESULTS: 15 trials involving 2166 participants met all the inclusion criteria. Antihistamines seemed to be no better than placebo. There was conflicting evidence on the effectiveness of antitussives, expectorants, antihistamine-decongestant combinations, and other drug combinations compared with placebo. CONCLUSION: Over the counter cough medicines for acute cough cannot be recommended because there is no good evidence for their effectiveness. Even when trials had significant results, the effect sizes were small and of doubtful clinical relevance. Because of the small number of trials in each category, the results have to be interpreted cautiously.

Acute Disease↗
PubMed2002

Labelling of acute respiratory illness: evidence of between-practitioner variation in the UK.

BACKGROUND: It is unclear which symptoms and signs GPs use when attributing diagnostic labels to patients with acute respiratory illness (ARI). OBJECTIVE: We sought to ascertain GPs' self-reported definitions of ARI. METHODS: A postal questionnaire concerned with the diagnosis of ARI was sent to all registered GPs in Avon Health Authority. GPs were asked to choose a clinical term that would describe the clinical presentation in four hypothetical patients, and the next three questions asked them to define acute bronchitis, upper respiratory tract infection (URTI) and any other term they used for ARI (excluding pneumonia). We measured proportions and compared responses across the three diagnostic categories. RESULTS: The majority (88%) of GPs agreed that cough associated with fever should be labelled as a URTI. When sputum and chest signs were also present, opinion was more divided, with 62% diagnosing acute bronchitis in young patients and 72% lower respiratory tract infection in old patients. CONCLUSIONS: This study demonstrates that there is more consistent use of diagnostic labels for URTI than for acute bronchitis or other terms used to label ARI. In the future, researchers should quantify the prognostic significance of symptoms and signs in ARI and provide GPs with a more rational approach to the diagnosis and management of ARI.

Acute Disease↗
PubMed2002

The treatment of acute bronchitis by general practitioners in the UK. Results of a cross sectional postal survey.

BACKGROUND: In Australia and the UK acute bronchitis is a common presenting problem in general practice. When symptoms persist management can be difficult and despite evidence that antibiotics are usually ineffective their use is widespread. OBJECTIVE: To describe prescribing behaviour for acute bronchitis by general practitioners in the United Kingdom. METHOD: Cross sectional postal survey of UK GPs. RESULTS: Four hundred and nineteen (73%) GPs responded. Purulent sputum, fever and crepitations/crackles on chest examination were the most important reasons for prescribing antibiotics: 89% of GPs said the colour of the sputum influenced their decision; amoxycillin was the first choice; 40% of GPs believed that at least one in five consultations for ARI were affected by patient factors, usually to maintain patient satisfaction. 47% of GPs advised the use of bronchodilators, and 96% recommended the symptomatic use of paracetamol and fluids. CONCLUSION: General practitioners are influenced to use antibiotics by patient symptoms and signs for which there is little evidence. Patient psychosocial factors influence prescribing. Until clearer research findings from new studies are available, GPs may opt for a 'just in case' prescription.

Acute Disease↗
PubMedDate not supplied

Preference-based antithrombotic therapy in atrial fibrillation: implications for clinical decision making.

BACKGROUND: Patient preferences and expert-generated clinical practice guidelines regarding treatment decisions may not be identical. The authors compared the thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines. METHODS: Methods included MEDLINE identification, systematic review, and pooling with some reanalysis of primary data from relevant studies. RESULTS: Eight pertinent studies, including 890 patients, were identified. These studies used 3 methods (decision analysis, probability tradeoff, and decision aids) to determine or model patient preferences. All methods highlighted that the threshold above which warfarin was preferred over aspirin was highly variable. In 6 of 8 studies, patient preferences indicated that fewer patients would take warfarin compared to the recommendations of the guidelines. In general, at a stroke rate of 1% with aspirin, half of the participants would prefer warfarin, and at a rate of 2% with aspirin, two thirds would prefer warfarin. In 3 studies, warfarin must provide at least a 0.9% to 3.0% per year absolute reduction in stroke risk for patients to be willing to take it, corresponding to a stroke rate of 2% to 6% on aspirin. CONCLUSIONS: For patients with atrial fibrillation, treatment recommendations from clinical practice guidelines often differ from patient preferences, with substantial heterogeneity in their individual preferences. Since patient preferences can have a substantial impact on the clinical decision-making process, acknowledgment of their importance should be incorporated into clinical practice guidelines. Practicing physicians need to balance the patient preferences with the treatment recommendations from clinical practice guidelines.

Aged↗