Journal of public health medicine
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J Public Health Med · Jun 2000
Comparative StudyPatient satisfaction with out-of-hours services; how do GP co-operatives compare with deputizing and practice-based arrangements?
Although the rapid growth in general practitioner (GP) co-operatives has met with GP satisfaction, little is known about patient satisfaction. This study compares patient satisfaction with co-operative, GP practice-based and deputizing arrangements within one geographical area 15 months after a co-operative had become established; and with telephone, primary care centre and home consultations within the co-operative. ⋯ Overall, patients were as satisfied with the co-operative as with practice-based or deputizing service arrangements, although many concerns were expressed about the quality of service provision. Differences in satisfaction were greater between forms of service delivery within the co-operative. Dissatisfaction with telephone consultations needs to be considered, together with issues relating to equity in access to out-of-hours' primary care centre consultations and the potential impact of NHS Direct.
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J Public Health Med · Jun 2000
Investigation of the association between excess winter mortality and socio-economic deprivation.
Excess winter mortality is higher in England and Wales than in other European countries with similar or lower average winter temperatures. It might be expected that excess winter mortality would be higher in areas with greater socio-economic deprivation, and if this were so preventive interventions could be directed at populations in these areas. The association between deprivation and excess winter mortality has not been adequately investigated in the past. The aim of this study was to look at the association between excess winter mortality and socio-economic deprivation, so that policy decisions to reduce this excess mortality could be appropriately directed. ⋯ Excess winter mortality is not associated with deprivation. Further research to identify the important aetiological factors and appropriate interventions to reduce excess winter mortality is needed.
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J Public Health Med · Jun 2000
Trade-offs between location and waiting times in the provision of health care: the case of elective surgery on the Isle of Wight.
Recent UK government documents have stated that, within the National Health Service, consumers should be more involved in decision-making. This study considered the technique of discrete choice conjoint analysis (DCCA) for eliciting community views regarding the importance of reducing waiting times. More specifically, the study aimed to establish whether residents living on the Isle of Wight are prepared to travel to the mainland for elective surgery where waiting times are shorter but travel costs may be greater, and, further, if residents are willing to travel, what reduction in waiting time and increase in travel costs would be acceptable. ⋯ Carrying out elective surgery on the mainland offers the potential to reduce waiting lists for island residents. The majority of respondents would be willing to travel to the mainland. However, one-fifth of respondents were not willing to travel to the mainland for elective surgery. The preferences of this group are important in policy decisions. More generally, the paper demonstrates the potential application of DCCA to public health issues.
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J Public Health Med · Jun 2000
Assessing the appropriateness of paediatric hospital admissions in the United Kingdom.
In order to assess whether the documented rise in paediatric admissions was due to inappropriate admissions, an objective measure of the appropriateness of paediatric admissions, modified for use in the United Kingdom, was used to measure the level of inappropriate admissions. The relationship of appropriateness of admissions to age, gender, time of admission and source of referral was investigated. ⋯ The low level of inappropriate admissions may be a reflection of well-developed primary care services in the United Kingdom. Alternatives to hospital admission for the assessment of minor self-limiting illness in young children may have a role in reducing inappropriate admissions.
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J Public Health Med · Jun 2000
Development of the Paediatric Appropriateness Evaluation Protocol for use in the United Kingdom.
This paper describes a study to develop and test an instrument to measure the level of appropriate admissions and days of care in the paediatric hospital population. ⋯ The modified PAEP achieved high reliability and was judged acceptable by clinicians to retrospectively assess the appropriateness of admissions in the UK setting.