Journal of public health medicine
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J Public Health Med · Dec 1999
Prescribing of beta-2 agonists and inhaled steroids in England: trends between 1992 and 1998, and association with material deprivation, chronic illness and asthma mortality rates.
British Thoracic Society guidelines published in 1990, revised in 1993 and 1997, recommended that general practitioners should make greater use of inhaled steroids in the management of asthma. British Thoracic Society guidelines have also been published on the management of chronic obstructive pulmonary disease. The objective of this study was to examine trends in the prescribing of beta-2 agonists and inhaled steroids in England between 1992 and 1998, and to investigate the variation at health authority level in the use of these drugs. ⋯ Prescribing of inhaled steroids has risen more quickly than that of beta-2 agonists between 1992 and 1998, resulting in a marked increase in the ratio of inhaled steroids to beta-2 agonists. At health authority level, there remains a wide variation in the use of beta-2 agonists and inhaled steroids.
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The Defence Medical Services provide to a British population healthcare services that are funded from taxation and are free at the point of delivery. This paper reviews some principles for determining entitlement to healthcare for the population cared for by the Defence Medical Services. The starting point for entitlement uses the principles under which the National Health Service (NHS) was established. These are then extended to acknowledge the limitations of an NHS model when considering occupational health issues and geographical variations in healthcare provision.
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The objective of this study was to compare differences in cost estimates for paediatric HIV hospital service provision based on hospital prices with cost estimates obtained through a research-based service-specific costing exercise. ⋯ In this hospital, reliance on generic hospital prices to derive cost estimates for paediatric HIV services produced considerable underestimates of the cost of service provision compared with data derived through the costing exercise. If this occurs across all or most areas of service provision, this can lead to substantial financial deficits, which in turn may mean that the needs of specific client populations may not be met.
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J Public Health Med · Jun 1999
Management of ischaemic heart disease in primary care: towards better practice. STaRNet. South Thames Region Network.
Ischaemic heart disease is the commonest cause of mortality in the United Kingdom. The objective of this study was to assess the management of patients with ischaemic heart disease in primary care, focusing particularly on the management of hypercholesterolaemia. ⋯ Systematic searches of computerized and paper medical records can identify subgroups of patients who will benefit from continuing follow-up in primary care. The results of this study suggest that ischaemic heart disease remains an area where there is scope to improve the management of patients in primary care. Considerable effort will be required from the members of the primary health care team to achieve this objective, particularly in the areas of computerized data collection and in the identification and recall of patients.