scholarly journals Variations in dementia diagnosis in England and association with general practice characteristics

2017 ◽  
Vol 18 (03) ◽  
pp. 235-241 ◽  
Author(s):  
Ian F. Walker ◽  
Paul A. Lord ◽  
Tracey M. Farragher
Keyword(s):  
General Practice ◽  
Secondary Data ◽  
Dementia Diagnosis ◽  
Cross Sectional ◽  
Practice List ◽  
Dementia Prevalence ◽  
Practice Characteristics ◽  
Diagnosis Of Dementia ◽  
Diagnosis Rate ◽  
The Uk

Objectives Improving dementia diagnosis rates in England has been a key strategic aim of the UK Government but the variation and low diagnosis rates are poorly understood. The aim of this study was to explore the variation in actual versus expected diagnosis of dementia across England, and how these variations were associated with general practice characteristics. Method A cross-sectional, ecological study design using secondary data sources and median regression modelling was used. Data from the year 2011 for 7711 of the GP practices in England (92.7%). Associations of dementia diagnosis rates (%) per practice, calculated using National Health Service England’s ‘Dementia Prevalence Calculator’ and various practice characteristics were explored using a regression model. Results The median dementia diagnosis rate was 41.6% and the interquartile range was 31.2–53.9%. Multivariable regression analysis demonstrated positive associations between dementia diagnosis rates and deprivation of the population, overall Quality and Outcomes Framework performance, type of primary care contract and size of practice list. Negative associations were found between dementia diagnosis rates and average experience of GPs in the practice and the proportion of the practice caseload over 65 years old. Conclusion Dementia diagnosis rates vary greatly across GP practices in England. This study has found independent associations between dementia diagnosis rates and a number of patient and practice characteristics. Consideration of these factors locally may provide targets for case-finding interventions and so facilitate timely diagnosis.

International work and leadership in UK general practice

2014 ◽  
Vol 27 (2) ◽  
pp. 87-103 ◽  
Author(s):  
Peter Young ◽  
Chris Smith ◽  
Luisa Pettigrew ◽  
Ha-Neul Seo ◽  
David Blane
Keyword(s):  
General Practice ◽  
Clinical Skills ◽  
High Income ◽  
Service Improvement ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Content Type ◽  
International Work ◽  
Low Middle Income Countries ◽  
The Uk

Purpose – The purpose of this paper is to present an exploration of the leadership competencies developed by UK GPs through having undertaken international work and the ability to transfer these competencies back to the UK. Design/methodology/approach – The approach taken is a cross-sectional survey. Findings – A total of 439 UK-based, ranging from GP specialty trainees to retired GPs who had worked overseas, responded to an online survey of UK general practice and international work. Doctors were asked to report competency development through international work using the domains of the Medical Leadership Competency Framework (MLCF). The most common competencies developed, to a “moderate or significant” degree, related to “personal qualities” (89 per cent) and “working in teams” (87 per cent). To a lesser extent Doctors developed competencies in “setting direction” (60 per cent), “managing services” (59 per cent), and “service improvement” (56 per cent), and found these competencies harder to transfer back to the UK. A common reason for limited transfer of competency was the lack of leadership opportunities for Doctors when returning to UK locum roles. Overseas posts were more common in low/middle income countries, and these Doctors reported a greater range of leadership roles, including in health policy, management and teaching, compared to high-income countries. Most doctors felt that they were able to develop their clinical skills overseas whilst relatively few Doctors performed research, especially in high-income countries. Originality/value – To the authors' knowledge this is the first cross-sectional survey exploring the international work of UK GPs and leadership development using the MLCF domains.

scholarly journals Medical applicant general practice experience and career aspirations: a questionnaire study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0023
Author(s):  
Priyesh Agravat ◽  
Tafsir Ahmed ◽  
Esme Goudie ◽  
Shahraz Islam ◽  
Douglas GJ McKechnie ◽  
...  
Keyword(s):  
General Practice ◽  
Work Experience ◽  
Questionnaire Study ◽  
Career Motivation ◽  
School Students ◽  
Cross Sectional ◽  
Practice Experience ◽  
Career Motivations ◽  
The Uk ◽  
The University

BackgroundIncreasing access to general practice work experience placements for school students is a strategy for improving general practice recruitment, despite limited evidence and concerns surrounding equity of access to general practice experiences.AimsTo examine the association between undertaking general practice experience and the perceptions of general practice as an appealing future career among prospective medical applicants. To identify socioeconomic factors associated with obtaining general practice experience.Design & settingCross-sectional questionnaire study in the UK.MethodParticipants were UK residents aged ≥16 years and seriously considering applying to study medicine in 2019/2020. They were invited to take part via the University Clinical Aptitude Test (UCAT). Questionnaire data were analysed using a linear regression of general practice appeal on general practice experience, adjusting for career motivations and demographics, and a logistic regression of general practice experience on measures of social capital and demographics.ResultsOf 6391 responders, 4031 were in their last year of school. General practice experience predicted general practice appeal after adjusting for career motivation and demographics (b = 0.37, standard error [SE] = 0.06, P<0.00001). General practice experience was more common among students at private (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.31 to 2.08, P<0.0001) or grammar schools (OR = 1.33, 95% CI = 1.02 to 1.72, P = 0.03) and in the highest socioeconomic group (OR = 1.62, 95% CI = 1.28 to 2.05, P<0.0001), and less likely among students of ‘other’ ethnicity (OR = 0.37, 95% CI = 0.20 to 0.67, P = 0.0011).ConclusionHaving general practice experience prior to medical school was associated with finding general practice appealing, which supports its utility in recruitment. Applicants from more deprived backgrounds were less likely to have had a general practice experience, possibly through lack of accessible opportunities.

scholarly journals Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey

2018 ◽  
Vol 68 (672) ◽  
pp. e469-e477 ◽  
Author(s):  
Thomas E Cowling ◽  
Azeem Majeed ◽  
Matthew J Harris
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Patient Survey ◽  
Cross Sectional ◽  
National Patient ◽  
General Practices ◽  
The Uk ◽  
Multilevel Linear Regression ◽  
Practice Patient

BackgroundThe UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.AimTo examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and settingAnalysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.MethodData from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.ResultsIn total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.ConclusionPatient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

scholarly journals Effectiveness of health education materials in general practice waiting rooms: a cross-sectional study

2018 ◽  
Vol 68 (677) ◽  
pp. e869-e876 ◽  
Author(s):  
Katherine Maskell ◽  
Paula McDonald ◽  
Priyamvada Paudyal
Keyword(s):  
General Practice ◽  
Health Education ◽  
Cross Sectional Study ◽  
Perceived Usefulness ◽  
Sectional Study ◽  
Waiting Room ◽  
Cross Sectional ◽  
Health Education Materials ◽  
The Uk ◽  
University Degree

BackgroundHealth education materials (HEMs) are widely used in general practice. However, there is little information on the variety of HEMs currently available to patients in the UK, or their preferences for accessing educational materials.AimTo assess patients’ perceptions of HEMs, and the variety and accessibility of these materials.Design and settingCross-sectional study conducted in general practices in Brighton and Hove.MethodAn anonymous questionnaire was distributed to patients in the waiting room (WR). Additionally, an audit was conducted to measure the variety of the HEMs. Results were analysed using binary multiple logistic regression.ResultsIn all, 556 participants (response rate 83.1%) from 19 practices took part. The mean age of participants was 49.3 years (SD ±18.9) and 63% were female. Perceived usefulness of HEMs was associated with reading in the WR using written HEMs, and not having a university degree; noticeability was associated with reading in the WR, and being female; attractiveness was associated with not having a university degree and shorter waiting time. On average, WRs contained 72 posters covering 23 topics, and 53 leaflets covering 24 topics, with many outdated and poorly presented materials of limited accessibility.ConclusionThis study found substantial variation in the amount, topicality, and quality of material available in WRs. As most patients notice HEMs and find them useful, available technology could be better utilised to widen access to HEMs. The introduction of wireless free internet (Wi-Fi) to waiting rooms should provide an opportunity to update this area.

Assessment of renal function based on cystatin C in elderly with dementia

2017 ◽  
Vol 41 (S1) ◽  
pp. S178-S178
Author(s):  
M.V. Zamfir ◽  
A.A. Talașman
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Correlation Coefficients ◽  
Clinical Problem ◽  
Cross Sectional Study ◽  
Dementia Diagnosis ◽  
Serum Cystatin C ◽  
Cross Sectional ◽  
Diagnosis Of Dementia

IntroductionAssessment of renal function in elderly with dementia is a difficult clinical problem due to the high prevalence of malnutrition and creatinine limits as a marker of glomerular filtration in this context.ObjectivesTo assess the correlation between renal function and dementia diagnosis.AimsTo highlight differences between methods of assessment of renal function based on creatinine and cystatin C.MethodsCross-sectional study. Patients institutionalized at Bucharest City-Center of Socio-Medical Services (a nursing home) from 04/2014 to 11/2014 were included in the study. Dementia diagnosis was established by a psychiatrist. We determined serum creatinine by Jaffe method and serum cystatin C by nephelometry. Renal function was determined using several formulas based on serum creatinine/cystatin C: Cockcroft–Gault, MDRD, creatinine CKDEPI/cystatin/creatinine + cystatin, Berlin Initiative Study (BIS1, BIS2), Lund-Malmo LM-LBM. To highlight a link between dementia and renal function, we determined Spearman correlation coefficients.ResultsThirty-one patients were included in the study, mean age 78.6 (63–97) years, 64% women. The diagnosis of dementia (1 = positive, 0 = negative) had the following statistically significant correlations: CKDEPIcystatin: rho = –0.390, P = 0.015; CKDEPI creatinine-cystatin: rho = –0.332, P = 0.032; BIS2: rho = –0.346, P = 0.02. We did not find statistically significant correlations between the diagnosis of dementia and formulas for assessing renal function based on creatinine only.ConclusionsElderly patients with dementia present decreased kidney function as determined by formulas based on cystatin/cystatin + creatinine, but not on creatinine alone. Assessment of renal function using cystatin C might represent a useful method for detection of renal dysfunction in these patients and for proper dosage of medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The Association between Care Left Undone and Temporary Nursing Staff ratios in Acute Settings: A cross- sectional survey of registered nurses

2020 ◽  
Author(s):  
Michaela Senek ◽  
STEVE ROBERTSON ◽  
TONY RYAN ◽  
RACHEL KING RN ◽  
EMILY WOOD ◽  
...  
Keyword(s):  
Registered Nurses ◽  
Nursing Staff ◽  
Online Survey ◽  
Health Workers ◽  
Secondary Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Difference ◽  
Temporary Staffing ◽  
The Uk

Abstract Background: The shortage of health workers is a global phenomenon. To meet increasing patient demands on UK health services, providers are increasingly relying on temporary staff to fill permanent posts. This study examines the occurrence of ‘care left undone’, understaffing and temporary staffing across acute sector settings. Methods: “Secondary data analysis from an RCN administered online survey covering nurses from hospitals and trusts across all four UK countries. Staffing and ‘care left undone’ measures were derived from the responses of 8,841 registered nurses across the UK. A locally smoothed scatterplot smoothing regression analysis (Loess) was used to model the relationship between any ‘care left undone’ events and full complement, modest and severely understaffed shifts, and proportions of temporary staff. Results: Occurrence of ‘care left undone’ was highest in Emergency Departments (48.4%) and lowest in Theatre settings (21%). The odds of ‘care left undone’ increase with increasing proportion of temporary staff. This trend is the same in all understaffing categories. On shifts with a full quota of nursing staff, an increase in the proportion of temporary staff from 0 to 10 per cent increases the odds of care left undone by 6 per cent (OR= 1.06, 95 % CI, 1.04-1.09). Within the full quota staffing category, the difference becomes statistically significant (p<0.05) on shifts with a proportion of temporary nursing staff of 40 per cent or more. On shifts with a full quota of nursing staff the odds of a ‘care left undone’ event is 10 per cent more with the proportion of temporary nursing staff at 50 per cent, compared to shifts with modest understaffing of 25 per cent or less with no temporary nursing staff (OR=1.1, 95%CI, 0.96-1.25). Conclusion: The odds of a ‘care left undone’ event are similar for fully staffed shifts with a high temporary nursing staff ratio compared to severely understaffed shifts with no temporary nursing staff. Increasing the proportion of temporary nurse staff is associated with higher rates of self-reported care left undone by nursing staff. This has significant implications for nurse managers and policy makers.

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