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Tom Walley

Publications and source records attributed to Tom Walley.

31 records · Page 2Linked to original sources
PubMed2003

Using disease registries for pharmacoepidemiological research: a case study of data from a cystic fibrosis registry.

BACKGROUND: The Epidemiologic Registry of Cystic Fibrosis (ERCF) was a multicentre, longitudinal follow-up project of cystic fibrosis patients enrolled at some 200 centres in nine European countries between 1994 and 1999. PURPOSE: We aimed to assess and improve the quality of a subset of data from the ERCF relating to seven English centres (1184 patients), prior to using the data for a long-term cost-effectiveness analysis of dornase alfa (Pulmozyme). Specifically we wanted to assess the completeness and accuracy of the data and the comparability of cases across centres. METHODS: We used a subset of ERCF data relating to seven UK cystic fibrosis (CF) centres. Following initial data editing, key variable data from a sample of patients from five centres were subjected to a detailed verification of ERCF data against original data sources available in the centres. Disagreements between ERCF reports and original data sources were identified and corrected in the study dataset. In addition, centre staff were questioned about relevant clinical and recording practices. RESULTS: Thanks to detailed routine data checking procedures on key variables operated by the ERCF, the rates of disagreement between ERCF data and original data as identified in our verification process on the assessed variables are generally low (0.4-3.7%). Some outcome variables (deaths, hospitalisations) seem to be under-reported by some centres. Episodes of pulmonary exacerbation are difficult to identify and also to verify. Twenty-four patients were registered twice (consecutively in two different centres). There were some differences between centres in their interpretation of recording rules. CONCLUSIONS: Researchers seeking to use disease registry data should consider detailed data quality review processes. Apart from data accuracy, reliable definitions of both critical events as well as their timing are important. The degree of under-reporting, particularly of outcome variables, should be estimated. Information on local clinical and reporting practices is necessary to interpret multi-centre data. Data protection issues may limit the possibilities for detailed data quality assessments of secondary data, as does the accessibility of original data for verification purposes. Our experiences and recommendations may be valuable for those intending to use disease registry data as well as those devising and operating such registries.

Adult↗
PubMed2003

Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow's doctors.

There is a pressing need for medical graduates to be fully prepared to take on the responsibilities of prescribing and to be able to respond to continual inevitable rapid changes in therapeutics. The curricula in UK medical schools were greatly influenced by Tomorrow's Doctors, published by the General Medical Council in 1993. This has recently been updated. While it highlights the management of disease and use of drugs as key learning objectives, it offers little specific guidance. In this document we expand on these broad statements, provide a view of how these learning objectives might be achieved, and identify the key elements of a core curriculum in prescribing and therapeutics.

Attitude of Health Personnel↗
PubMed2003

Diltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporin.

BACKGROUND: Usage of cyclosporin (the Hong Kong Hospital Authority's single largest item of drug expenditure) continues to increase, mainly due to increasing numbers of renal allograft patients taking it as long-term antirejection therapy. Diltiazem, an antihypertensive agent, interferes with the first pass extraction of oral cyclosporin, thus serving to conserve its dosage. AIMS: In renal transplant patients, to assess whether diltiazem co-treatment could achieve worthwhile dosage conservation of Neoral (a relatively new microemulsified cyclosporin formulation), safely. METHODS: A randomized, placebo-controlled, double-blind clinical trial was undertaken at three local hospitals. Renal transplant recipients receiving Neoral as prophylactic immunosuppression were randomized to two treatment arms. Active treatment consisted of diltiazem tablets 30 or 60 mg twice daily for patients weighing < 60 or >or= 60 kg, respectively. One hundred and ten eligible patients gave their informed consent, and were followed up for at least six months. The mean difference in the dollar cost in the sixth month was the primary outcome. Secondary/ancillary outcomes included changes in cyclosporin dosage and blood level, and untoward clinical events including rejection. Outcomes were evaluated by intention to treat analyses. RESULTS: During weeks 23-26 (sixth month) post randomization, diltiazem co-treatment yielded an estimated average cost saving per patient on drugs of 15%[the 95% confidence interval (CI) of the difference being HK dollars 609 +/- 517 or pound 50 +/- 42], with no apparent excess of untoward or adverse events, complications, hospitalization, outpatient visits, or inferior quality of life. CONCLUSIONS: This diltiazem co-treatment regime applied to the nearly 1800 surviving renal allograft patients followed up in Hospital Authority hospitals could have saved approximately HK dollars 14.3 million ( pound 1.17 million) annually, without adverse sequelae.

Adolescent↗
PubMed2003

Influences on GPs' decision to prescribe new drugs-the importance of who says what.

OBJECTIVES: The aim of this study was to understand the range of factors that influence GPs' uptake of new drugs METHODS: A total of 107 GPs selected purposively from high, medium and low new drug prescribing practices in two health authorities in the north west of England were interviewed using the critical incident technique with semi-structured interviews. Interview topics included reasons for prescribing new drugs launched between January 1998 and May 1999; reasons for prescribing the new drug rather than alternatives; and sources of information used for each prescribed drug. RESULTS: Important biomedical influences were the failure of current therapy and adverse effect profile. More influential than these, however, was the pharmaceutical representative. Hospital consultants and observation of hospital prescribing was cited next most frequently. Patient request for a drug, and patient convenience and acceptability were also likely to influence new drug uptake. Written information was of limited importance except for local guidelines. GPs were largely reactive and opportunistic recipients of new drug information, rarely reporting an active information search. The decision to initiate a new drug is heavily influenced by 'who says what', in particular the pharmaceutical industry, hospital consultants and patients. The decision to 'adopt' a new drug is clinched by subsequent personal clinical experience. CONCLUSIONS: Prescribing of new drugs is not simply related to biomedical evaluation and critical appraisal but, more importantly, to the mode of exposure to pharmacological information and social influences on decision making. Viewed within this broad context, prescribing variation becomes more understandable. Findings have implications for the implementation of evidence-based medicine, which requires a multifaceted approach.

Decision Making↗
PubMed2003

New drug uptake: qualitative comparison of high and low prescribing GPs' attitudes and approach.

BACKGROUND: Prescribing varies considerably between GPs, and a minority of GPs account for a large proportion of new drug prescribing. OBJECTIVE: Our aim was to explore the differences in approach and attitudes towards new drug prescribing between high and low GP prescribers. METHODS: Semi-structured interviews were undertaken with 30 GPs who were either high or low prescribers of new drugs. Interview topics included reasons for prescribing new drugs; use of information sources; attitudes and approach to drug innovation; and consideration of the balance of risk and therapeutic benefit. RESULTS: Differences in GPs' appraisal of new drugs enabled the development of a classification of attitudes and approaches applying to high and low prescribers. Difference in the behaviours of each group is a matter of degree of attitude or influence rather than (usually) its absence. Key dimensions in the classification are attitudes towards new drug prescribing, perception of risk and benefits, strategies adopted for risk management, information-seeking behaviour and use of the pharmaceutical industry as a significant information source. CONCLUSION: Variability in GP prescribing of new drugs relates not only to levels of acquired knowledge, but also to differences in subjective and ideological beliefs.

Attitude of Health Personnel↗
PubMed2003

A reliability study of an instrument for measuring general practitioner consultation skills: the LIV-MAAS scale.

OBJECTIVE: To evaluate the reliability of a new tool, the LIV-MAAS, in assessing consultation competence in UK general practice. DESIGN: These were pilot studies, with small numbers of participants. Videoed general practitioner (GP) consultations were analysed by trained lay and professional raters, using the LIV-MAAS. The inter-rater reliabilities were assessed. Four videos were assessed by five raters in a pilot study. After this, 71 consultations from eight doctors were assessed by sets of three raters. MAIN MEASURES: Inter-rater reliabilities and inter-consultation reliabilities. RESULTS: For the pilot study, the estimated inter-rater reliability ranged from 0.69 (one rater) to 0.91 (five raters). For the main study, the estimated inter-rater reliability for the LIV-MAAS checklist using two raters was 0.71, and using three raters it was 0.78. Mean differences in reliability within each series of nine consultations were 0.20 (three raters) and 0.42 (two raters). CONCLUSIONS: As a measure of 'consultation competence', administered by trained raters (medical or lay) to real GP consultations, the LIV-MAAS instrument shows adequate reliability and stability but would benefit from considerable shortening. Further development of the LIV-MAAS and testing with larger samples are required.

Adult↗
PubMed2003

Treatment for newly diagnosed hypertension: patterns of prescribing and antihypertensive effectiveness in the UK.

Improved practice in the management of hypertension depends on an understanding of existing patterns of treatment. To describe the management of newly diagnosed hypertension in British general practice and the effectiveness of current prescribing patterns we conducted a retrospective observational study using data from a computerized general practitioner record database (DIN-LINK). 21 024 patients were first treated for newly diagnosed hypertension between January 1993 and December 1997, and were followed for 4 years. Diuretics or beta-blockers were the most widely prescribed first-line treatments, used in 54% of patients. The mean continuation rate for first-line therapy was 69% at 12 months: the continuation rate was highest for angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists. After 12 months of treatment the mean blood pressure reduction was 19/10 mmHg. Blood pressure targets were met in only 14% of patients. After 48 months of treatment 34% of patients had not improved in band of blood pressure severity. Many patients with severe hypertension at 12 months were still being prescribed only one drug. The lack of aggression in antihypertensive treatment, indicated by the low number of agents prescribed and the failure to achieve targets, is disappointing. Prescribing patterns for first-line therapy corresponded to guidelines. Continuation rates on first-line therapy were higher than often reported. The choice of drug for additions to or switches from first-line therapy had no clear pattern. Routinely collected computerized data could be used to support clinical governance activities in primary care.

Antihypertensive Agents↗
PubMed2003

Understanding why GPs see pharmaceutical representatives: a qualitative interview study.

BACKGROUND: Doctors are aware of the commercial bias in pharmaceutical representative information; nevertheless, such information is known to change doctors' prescribing, and augment irrational prescribing and prescribing costs. AIM: To explore GPs, reasons for receiving visits from pharmaceutical representatives. DESIGN OF STUDY: Qualitative study with semi-structured interviews. SETTING: One hundred and seven general practitioners (GPs) in practices from two health authorities in the North West of England. RESULTS: The main outcome measures of the study were: reasons for receiving/not receiving representative visits; advantages/disadvantages in receiving visits; and quality of representative-supplied information. Most GPs routinely see pharmaceutical representatives, because they bring new drug information speedily; they are convenient and accessible; and can be consulted with a saving of time and effort. Many GPs asserted they had the skills to critically appraise the evidence. Furthermore, the credibility and social characteristics of the representative were instrumental in shaping GPs' perceptions of representatives as legitimate information providers. GPs also received visits from representatives for reasons other than information acquisition. These reasons are congruent with personal selling techniques used in marketing communications. CONCLUSIONS: The study draws attention to the social and cultural contexts of GP-representative encounters and the way in which the acquisition of pharmacological information within the mercantile context of representative visits is legitimated. This highlights the need for doctors to critically appraise information supplied by representatives in relation to other information sources.

Drug Industry↗
PubMed2002

Using drugs safely.

Explore the source record for details and available documents.

Drug Prescriptions↗
PubMed2002

Lifestyle medicines and the elderly.

Lifestyle medicines are those used to meet patient aspirations rather than traditionally defined medical need. However, in many cases, the boundary between the two is ill defined and a matter of degree or cultural expectation. Such medicines are not yet widely used by the elderly, but this may change in an increasingly consumerist society. There are ethical, clinical and financial issues to be considered around these drugs, which are not independent. The ethical issues relate mainly to the rising consumerism in medicine, and whether these and other medicines are consumer goods available almost on demand. The clinical issues concern the balancing of risk and benefit for these medicines, and how we inform patients of these issues. The financial issues are who should pay and whether third party payers can and should ration these medicines and, if so, how. Lifestyle medicines may provoke a debate on the whole issue of rationing. These issues are not confined to the use of these medicines by the elderly and their resolution will depend on a broader societal debate, in which the elderly need to be active.

Aged↗
PubMed2002

Measuring consultation skills in primary care in England: evaluation and development of content of the MAAS scale.

BACKGROUND: Consultation skills are essential for general practice. Tools for measuring consultation skills in everyday practice are not well developed AIM: To examine and develop the content validity of the MAAS History-taking and Advice Checklist GP (MAAS-GP) tool which is used in The Netherlands for testing consultation skills, with simulated patients in United Kingdom general practice from the perspectives of both general practitioners and patients. DESIGN OF STUDY: Qualitative research using semi-structured interviews. SETTING: Alternate patients attending seven general practices in the north west of England. METHOD: Thematic analysis of the contents of patient and GP interviews, and of focus groups, mapping key themes to the MAAS-GP. RESULTS: There was strong agreement between patients and GPs on issues mapping to 46 out of 68 items of the MAAS-GP. Eight further MAAS-GP items were linked to issues only raised by patients and four to issues raised only by GPs. The remaining 10 items could not be related to issues raised by either. All of the issues raised by GPs could be mapped but 27 patient items could not. These were included in a revised checklist, the Liverpool MAAS (LIV-MAAS). CONCLUSION: the revised tool seems to have content validity in measuring consultation skills. Measurement of its relability is now required.

Adult↗
PubMedDate not supplied

Regulating pharmaceutical markets: improving efficiency and controlling costs in the UK.

UK government policy on pharmaceuticals is broadly integrated across the whole of health care policy. In the early 1990s, cost containment was emphasized, through budget holding by doctors to ensure clinical acceptability. From 2000 onwards, increased government funding for the NHS has allowed expansion of services and prescribing in areas of public health importance, but has been coupled with increased accountability and ambitious targets for the process of care and health outcomes. Standards for care are set in national guidelines including those from the National Institute for Clinical Excellence (NICE). NICE recommends or rejects new technologies to the NHS for their clinical value and cost effectiveness. Although following its advice is mandatory, evidence so far suggests that it has been only partly successful at improving services and eliminating variations. GP prescribing is monitored by Primary Care Organisations (PCO) which also hold the medicines budget. They may provide incentives to GPs for meeting targets in quality or expenditure. The UK government regulates the prices of generics but not of branded medicines; instead it regulates the profitability of the pharmaceutical industry. This arrangement seems to have been successful both at maintaining a major employer and export earner, and in limiting high drug expenditure.

Cost Control↗