Journal of public health medicine
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A key element within the programme of reform introduced into the UK National Health Service in the 1990s has been the concept of health needs assessment, which must be undertaken by health care purchasers as a guide to the planning process. As part of a wide-ranging study of the impact of the NHS reforms on hospices and specialist palliative care services, providers' perceptions of needs assessment for palliative care were examined, including the extent to which needs assessments had been carried out in local districts, together with the implications. ⋯ Palliative care needs assessment has considerable potential to influence future purchasing and service provision, yet not all health commissions are undertaking it. There is a high level of provider enthusiasm for palliative care needs assessment, albeit coupled to low levels of technical knowledge and a lack of involvement in the process at local level. Purchaser-provider dialogue on needs assessment should focus on both raising awareness of appropriate techniques and debating 'ethical neutrality' about the outcome.
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J Public Health Med · Dec 1997
Factors associated with utilization of specialist palliative care services: a population based study.
Palliative care services have been criticized for providing specialist care for a privileged few but there is no routinely available information to prove or refute these criticisms. Our survey aimed to identify and describe the patients using specialist palliative care services in a Health District and identify whether any factors distinguished them from other eligible patients who did not use these services. ⋯ Effectiveness studies in the field of palliative care are essential but difficult. We suggest that there is an important place for local studies of needs and utilization for guiding sensitive contracting.
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J Public Health Med · Sep 1997
Breast, lung and colorectal cancer incidence and survival in South Thames Region, 1987-1992: the effect of social deprivation.
This paper describes the relationship between social deprivation and incidence of, and survival from, breast, lung, and colorectal cancers among residents of the South Thames regions. We analysed 23,505 cases of breast cancer, 29,903 cases of lung cancer and 21,905 cases of colorectal cancer, aged 40-99 inclusive at diagnosis and diagnosed between 1 January 1987 and 31 December 1992. ⋯ Survival differences by deprivation status exist in South Thames among patients suffering from breast or colorectal cancers and are not explained by differences in the incidences of these diseases. For lung cancer, incidence and mortality were positively correlated with deprivation, but no socio-economic gradient was found for survival.