Commissioning Processes in Primary Care Trusts: A Repeated Cross-Sectional Survey of Health Care Commissioners in England

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 31-39 ◽  
Author(s):  
Fiona Sampson ◽  
Alicia O'cathain ◽  
Mark Strong ◽  
Mark Pickin ◽  
Lisa Esmonde
Keyword(s):  
Primary Care ◽  
Urgent Care ◽  
Chronic Obstructive ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Telephone Surveys ◽  
The Public ◽  
And Performance ◽  
Clinical Engagement

Objectives To determine the extent to which primary care trusts (PCTs) in England employed processes associated with quality commissioning and to assess whether changes occurred in these processes during a policy drive to improve commissioning. Methods Telephone surveys of PCT managers leading commissioning for diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), and emergency and urgent care in all 152 PCTs in both 2009 and 2010. Results The response rate was 51% (77/152) of PCTs in 2009 and 60% (91/152) in 2010. Two-thirds of commissioners had commissioned initiatives starting in the previous financial year. Over half of initiatives starting in 2008/09 had been instigated by the PCT alone. This reduced to a third in 2010, showing a shift towards partnership working. Commissioners reported that a large proportion of initiatives had been developed and shaped with the involvement of general practitioners (GPs) with direct links to the PCT and of specialist clinicians (70%), but that a lower proportion of initiatives had involvement from other GPs (40%). Patients or the public were less likely to be involved in initiatives than clinicians, but there was evidence of increasing involvement over the two years from 35% (52/149) to 51% (67/132) of initiatives. There was no evidence of changes in whether needs assessment was undertaken, how evidence was used or how initiatives were led and performance managed. Conclusions PCT commissioners reported clinical engagement in the majority of commissioning initiatives, a shift towards partnership commissioning, and increased involvement of patients and public in the development of initiatives. The new model of commissioning in England through clinical commissioning groups will need to improve on these processes if it is to demonstrate a higher quality approach to commissioning.

scholarly journals Chronic obstructive pulmonary disease and comorbidities: a large cross-sectional study in primary care

2017 ◽  
Vol 67 (658) ◽  
pp. e321-e328 ◽  
Author(s):  
Ula Chetty ◽  
Gary McLean ◽  
Deborah Morrison ◽  
Karolina Agur ◽  
Bruce Guthrie ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Integrated Approach ◽  
Chronic Obstructive ◽  
Physical And Mental Health ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Health Comorbidities

BackgroundChronic obstructive pulmonary disease (COPD) is common, and a major cause of morbidity and mortality worldwide. Recent studies suggest that comorbidities of COPD increase the risk of hospitalisation, polypharmacy, and mortality, but their estimated prevalence varies widely in the literature.AimTo evaluate the prevalence of 38 physical and mental health comorbidities in people with COPD, and compare findings with those for people without COPD in a large nationally representative dataset.Design and settingA cross-sectional data analysis on 1 272 685 adults in Scotland from 314 primary care practices.MethodData on COPD, along with 31 physical and seven mental health comorbidities, were extracted. The prevalence of comorbidities was compared between people who did, and did not, have COPD, standardised by age, sex, and socioeconomic deprivation.ResultsFrom the total sample, 51 928 patients had COPD (4.1%). Of these, 86.0% had at least one comorbidity, compared with 48.9% of people without COPD. Of those with COPD, 22.3% had ≥5 comorbid conditions compared with 4.9% of those who did not have COPD (adjusted odds ratio 2.63, 95% confidence interval = 2.56 to 2.70). In total, 29 of the 31 physical conditions and six of the seven mental health conditions were statistically significantly more prevalent in people who had COPD than those who did not.ConclusionPatients with COPD have extensive associated comorbidities. There is a real need for guidelines and health care to reflect this complexity, including how to detect those common comorbidities that relate to both physical and mental health, and how best to manage them. Primary care, which is unique in terms of offering expert generalist care, is best placed to provide this integrated approach.

scholarly journals Significance of platelet counts in health and disease: Insights from a population study using data from the National Health and Nutrition Examination Survey

2019 ◽  
Vol 7 (30) ◽  
pp. 4-11
Author(s):  
Sariya Wongsaengsak ◽  
Jeff Dennis ◽  
Meily Arevalo ◽  
Somedeb Ball ◽  
Kenneth Nugent
Keyword(s):  
Population Study ◽  
National Health ◽  
Mexican Americans ◽  
Large Population ◽  
Chronic Obstructive ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Health And Disease ◽  
Using Data

Background: Platelets are important mediators of coagulation, inflammation, andatherosclerosis. We conducted a large population study with National Health and NutritionExamination Survey (NHANES) data to understand the relationship of total platelet count(TPC) with health and disease in humans.Methods: NHANES is a cross-sectional survey of non-institutionalized United States adults,administered every 2 years by the Centers for Disease Control and Prevention. Participantsanswer a questionnaire, receive a physical examination, and undergo laboratory tests. TPCvalues were analyzed for a six-year period of NHANES (2011–2016). Weighted 10th and 90thpercentiles were calculated, and logistic regression was used to predict likelihood (Odds ratio[OR]) of being in categories with TPC < 10th percentile or > 90th percentile. Statistical analysiswas performed using Stata/SE 15.1, using population weights for complex survey design.Results: The mean TPC for our sample (N = 17,969) was 236 × 103/μL (SD = 59 × 103)with the 10th percentile 170 × 103/μL and the 90th percentile 311 × 103/μL. Hispanics (otherthan Mexican Americans) and obese individuals had lower odds of a TPC < 10th percentile.Males, Blacks, adults aged ≥ 45 years, and those with a recent (last 12 months) hospital staywere more likely to have a TPC < 10th percentile. Obese individuals and Mexican Americanshad higher odds of having TPC > 90th percentile. Individuals with a congestive heart failure(CHF) or coronary heart disease (CHD) diagnosis had over twice the odds (OR 2.06, 95% CI:1.50-2.82, p =< 0.001, and 2.11, 95% CI: 1.48-3.01, p =< 0.001, respectively) of having TPC<10th percentile. Individuals with an emphysema or asthma diagnosis were more likely to haveTPC > 90th percentile (OR 1.84, 95% CI: 1.08-3.13, p = 0.026, and 1.25, 95% CI: 1.00-1.56,p = 0.046, respectively). A diagnosis of chronic obstructive pulmonary disease and cancer didnot have significant associations with TPC.Conclusions: Our study showed that obese individuals are more likely to havehigher TPC. Individuals with CHF and CHD had higher odds of having TPC < 10thpercentile, and those with emphysema and asthma were more likely to have TPC > 90thpercentile.

scholarly journals Relationship between Smoking Activity and Chronic Obstructive Pulmonary Disease in the Zainoel Abidin General Hospital, Banda Aceh, Indonesia

2020 ◽  
Vol 8 (B) ◽  
pp. 705-707
Author(s):  
Liza Salawati ◽  
Husnah Husnah ◽  
Yusuf Nawawi ◽  
Zainal A. Muchlisin
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
General Hospital ◽  
Pulmonary Disease ◽  
Stage Iii ◽  
Chronic Obstructive ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Banda Aceh ◽  
Heavy Smokers

BACKGROUND: Exposure to cigarette smoke is one risk factor that can lead to the development of chronic obstructive pulmonary disease (COPD). AIM: The aim of this study was to examine the relationship between smoking and the stage of COPD. METHODS: This study used a cross-sectional survey design. A total of 60 COPD patients were involved in the study between September and November 2015 at the pulmonary ward of Zainoel Abidin General Hospital (ZAGH), Banda Aceh, Indonesia. The data were analyzed with the non-parametric bivariate test. RESULTS: The results showed that 55% of patients with COPD were aged between 40 and 60 years; 63.33% of them were heavy smokers. About 50% of moderate smokers suffered from Stage III COPD, while 34.21% of heavy smokers suffered from Stage III and Stage VI (severe) COPD, respectively, with p = 0.007. CONCLUSIONS: There is a strong relationship between smoking and COPD stage among patients at ZAGH.

scholarly journals Phenotypic Variation in Patients with Chronic Obstructive Pulmonary Disease in Primary Care

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Emmylou Beekman ◽  
Ilse Mesters ◽  
Mark G. Spigt ◽  
Eva A. M. van Eerd ◽  
Rik Gosselink ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Airway Obstruction ◽  
Physical Therapist ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Phenotypic Differences

Introduction. Despite the high number of inactive patients with COPD, not all inactive patients are referred to physical therapy, unlike recommendations of general practitioner (GP) guidelines. It is likely that GPs take other factors into account, determining a subpopulation that is treated by a physical therapist (PT). The aim of this study is to explore the phenotypic differences between inactive patients treated in GP practice and inactive patients treated in GP practice combined with PT. Additionally this study provides an overview of the phenotype of patients with COPD in PT practice.Methods. In a cross-sectional study, COPD patient characteristics were extracted from questionnaires. Differences regarding perceived health status, degree of airway obstruction, exacerbation frequency, and comorbidity were studied in a subgroup of 290 inactive patients and in all 438 patients.Results. Patients treated in GP practice combined with PT reported higher degree of airway obstruction, more exacerbations, more vascular comorbidity, and lower health status compared to patients who were not referred to and treated by a PT.Conclusion. Unequal patient phenotypes in different primary care settings have important clinical implications. It can be carefully concluded that other factors, besides the level of inactivity, play a role in referral to PT.

scholarly journals Clinico-epidemiological characteristics of men and women with a new diagnosis of chronic obstructive pulmonary disease: a database (SIDIAP) study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Josep Montserrat-Capdevila ◽  
Josep Ramon Marsal ◽  
Marta Ortega ◽  
Maria Teresa Castañ-Abad ◽  
Miquel Alsedà ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Pulmonary Disease ◽  
Cor Pulmonale ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Epidemiological Characteristics ◽  
Strength Of Association

Abstract Background The risk of developing Chronic Obstructive Pulmonary Disease (COPD), the associated comorbidities and response to bronchodilators might differ in men and women. The objective of this study was to determine the prevalence of COPD and the clinic-epidemiological characteristics of primary care patients with COPD according to gender. Methods This is a cross-sectional study using electronic healthcare records Catalonia (Spain), during the 01/01/2012–31/12/2017 period. Patients from the SIDIAP database (System for the Development of Research in Primary Care) were included (5,800,000 patients registered in 279 primary care health centres). Clinic-demographic characteristics, comorbidities and blood tests results were collected for each patient. Adjusted OR (ORa) with logistic regression methods were used to determine variables associated with men and women. Results From an initial sample of 800,899 people, 24,135 (3%) were considered COPD patients, and 22.9%were women. The most common risk factors in women were bronchiectasis (ORa = 20.5, SD = 19.5–21.6), age > 71 years (ORa = 18.8; SD = 17.3–20.5), cor pulmonale (ORa = 5.2; SD = 4.3–6.7) and lung cancer (ORa = 3.6, SD = 3.2–4.0). Men and women presented the same comorbidities, though the strength of association was different for each gender. Conclusions Patients suffering high comorbidity rates. Comorbidities are similar in men and women, although the strength of association varies according to gender. Women are more susceptible to the harmful effects of smoking and present a higher proportion of bronchiectasis and OSAS.

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