Abstract:
OBJECTIVE:To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements. DESIGN:Description of the procedures for managing extracontractual referrals and the decisions made on requests submitted to the district health authority between 1 April and 30 June 1991. RESULTS:235 requests were submitted, 79 for emergency care. 156 requests were clearly for elective treatments and, of these, 61 were ultimately refused, 20 because the district health authority was not liable to pay. Of the remaining 41, 17 were appealed successfully and three unsuccessfullly. More than half of the elective extracontractual referrals correctly submitted were to either orthopaedics, general surgery, oral surgery, gynaecology, or plastic surgery. Overall, the district health authority approved three quarters of the requests for which it would be financially liable; this was the predicted workload for the period. CONCLUSIONS:The management of extracontractual referral requests is complex and time consuming for clinicians and managers alike. Patient choice is clearly being limited to some extent, but this is necessary if the number of requests is not to exceed the levels on which funding is based.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Williamson JDdoi
10.1136/bmj.303.6801.499subject
Has Abstractpub_date
1991-08-31 00:00:00pages
499-504issue
6801eissn
0959-8138issn
1756-1833journal_volume
303pub_type
杂志文章abstract:OBJECTIVES:To investigate the effect of Chlamydia pneumoniae infection on future development of ischaemic heart disease and mortality. DESIGN:Prospective longitudinal study. SETTING:Caerphilly, South Wales. SUBJECTS:Plasma specimens were collected during 1979-83 from 1773 men aged 45-59 years. These were tested for ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.318.7190.1035
更新日期:1999-04-17 00:00:00
abstract:OBJECTIVE:To review and critically appraise published and preprint reports of prediction models for diagnosing coronavirus disease 2019 (covid-19) in patients with suspected infection, for prognosis of patients with covid-19, and for detecting people in the general population at increased risk of becoming infected with...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m1328
更新日期:2020-04-07 00:00:00
abstract:OBJECTIVE:To investigate explanations for social inequalities in health with respect to health related social mobility and cumulative socioeconomic circumstances over the first three decades of life. DESIGN:Longitudinal follow up. SETTING:Great Britain. SUBJECTS:Data from the 1958 birth cohort study (all children bo...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7055.449
更新日期:1996-08-24 00:00:00
abstract::A study was carried out analysing the operation of a drug rationalisation programme in a central London teaching district that had evolved from experience over 17 years. Creation of a limited list of about 700 drugs had been achieved by local consensus. Drug selection was based on appraisal of efficacy, safety, and co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6646.465
更新日期:1988-08-13 00:00:00
abstract:OBJECTIVES:To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compli...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d3245
更新日期:2011-06-13 00:00:00
abstract:OBJECTIVES:To calculate socioeconomic and health status measures for the primary care groups in London and to examine the association between these measures and hospital admission rates. DESIGN:Cross sectional study. SETTING:66 primary care groups in London, total list size 8.0 million people. MAIN OUTCOME MEASURES:...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.321.7268.1057
更新日期:2000-10-28 00:00:00
abstract:OBJECTIVE:To compare the efficacy and safety of rectal artemether with intravenous quinine in the treatment of cerebral malaria in children. DESIGN:Randomised, single blind, clinical trial. SETTING:Acute care unit at Mulago Hospital, Uganda's national referral and teaching hospital in Kampala. PARTICIPANTS:103 child...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.330.7487.334
更新日期:2005-02-12 00:00:00
abstract:OBJECTIVE:To evaluate the incidence of serious maternal complications after the use of various tocolytic drugs for the treatment of preterm labour in routine clinical situations. DESIGN:Prospective cohort study. SETTING:28 hospitals in the Netherlands and Belgium. PARTICIPANTS:1920 consecutive women treated with toc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b744
更新日期:2009-03-05 00:00:00
abstract::Environmental issues tend to greater political attention than do environmental health aspects. Therefore, when conflicts of interest occur with other environmental concerns, negative consequences for public health may result. For example, a strategy to substantially reduce indoor ventilation in many dwellings in Sca...
journal_title:BMJ (Clinical research ed.)
pub_type: 社论
doi:10.1136/bmj.318.7199.1636
更新日期:1999-06-19 00:00:00
abstract:OBJECTIVE:To confirm the findings of pilot studies that interferon alfa is an effective treatment of Europid men with chronic hepatitis B virus infection. DESIGN:Randomised controlled trial of three months treatment with interferon alfa followed by 12 months of observation. SETTING:Outpatient clinic of a tertiary ref...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.299.6700.652
更新日期:1989-09-09 00:00:00
abstract:OBJECTIVE:To determine whether women with atrial fibrillation have a higher risk of stroke than men. DESIGN:Nationwide retrospective cohort study. SETTING:Patients with a diagnosis of atrial fibrillation in the Swedish hospital discharge register between 1 July 2005 and 31 December 2008. Information about drug treatm...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e3522
更新日期:2012-05-30 00:00:00
abstract:OBJECTIVE:To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. DESIGN:Longitudinal analysis. SETTING:35 medical facilities of Kaiser Permanente Northern California, 1997-2007. PARTICIPANTS:...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c1898
更新日期:2010-05-11 00:00:00
abstract:OBJECTIVES:To compare the efficacy and tolerability of butterbur (Petasites hybridus) with cetirizine in patients with seasonal allergic rhinitis (hay fever). DESIGN:Randomised, double blind, parallel group comparison. SETTING:Four outpatient general medicine and allergy clinics in Switzerland and Germany. PARTICIPA...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7330.144
更新日期:2002-01-19 00:00:00
abstract:OBJECTIVES:To determine whether fibrinogen and lipid concentrations are risk factors for ischaemic stroke. DESIGN:Case-control study with a population based comparison within the overall study. SETTING:Oxfordshire community stroke project and a neurology clinic. SUBJECTS:105 patients who had a transient ischaemic at...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6803.605
更新日期:1991-09-14 00:00:00
abstract::Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.Setting Primary care...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j603
更新日期:2017-02-21 00:00:00
abstract:OBJECTIVES:To examine trends over time in the rates of admission to hospital for accidents of preschool children and to study patterns of repeated admissions for accidents in these children. DESIGN:Analysis of linked, routine abstracts of hospital inpatient records for accidents. SETTING:Six districts in the Oxford R...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6767.16
更新日期:1991-01-05 00:00:00
abstract:OBJECTIVES: To provide contemporary estimates of the prevalence of microcephaly in Europe, determine if the diagnosis of microcephaly is consistent across Europe, and evaluate whether changes in prevalence would be detected using the current European surveillance performed by EUROCAT (the European Surveillance of Conge...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.i4721
更新日期:2016-09-13 00:00:00
abstract:OBJECTIVE:To compare perinatal outcomes in births of women with versus without a history of bariatric surgery. DESIGN:Population based matched cohort study. SETTING:Swedish national health service. PARTICIPANTS:1,742,702 singleton births identified in the Swedish medical birth register between 1992 and 2009. For eac...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f6460
更新日期:2013-11-12 00:00:00
abstract:OBJECTIVE:To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia. DESIGN:Systematic overview and meta-regression analyses of randomised controlled trials, as a basis for formal development of guidelines. SUBJECTS:12 649 patients in 52 randomised trials co...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.321.7273.1371
更新日期:2000-12-02 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN:Randomised clinical trial. SETTING:Primary health care in the Netherlands. PATIENTS:256 patients with non...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.304.6827.601
更新日期:1992-03-07 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery. DESIGN:Randomised controlled trial. SETTING:Regional cardiac centre in a teaching hospital in Southampton. PARTICIPANTS:263 adults ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7349.1299
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower limb revascularisation surgery. DESIGN:Comparative effectiveness study using linked, validated, population based databases. SETTING:Onta...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m4104
更新日期:2020-11-25 00:00:00
abstract:OBJECTIVE:To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS. DESIGN:Follow-up of cluster randomised trial 4.5 years after intervention. SETTING:NHS records of women who...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.39014.503692.55
更新日期:2007-01-20 00:00:00
abstract:OBJECTIVE:To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN:Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and ni...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.883
更新日期:1993-04-03 00:00:00
abstract:OBJECTIVE:To compare blood pressure control, satisfaction, and adherence to drug treatment in patients with treated hypertension followed up by their family physicians either every three months or every six months for three years. DESIGN:Randomised equivalence clinical trial. Settings 50 family practices in south east...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.37967.374063.EE
更新日期:2004-01-24 00:00:00
abstract:OBJECTIVE:To prepare and assess the sensitivity and specificity of a latex agglutination test specific for the serotype of antigen in diagnosing pneumococcal pneumonia in Gambian children. DESIGN:Comparison of agglutination test specific for serotype with culture of blood and lung aspirates, countercurrent immunoelect...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.298.6680.1061
更新日期:1989-04-22 00:00:00
abstract:OBJECTIVES:To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes. DESIGN:We undertook a cost-utility analysis that used data from a 12 month, mu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c4093
更新日期:2010-08-20 00:00:00
abstract:OBJECTIVES:Analysis of incidence and characteristics of congenital abdominal wall defects, with special reference to the differences between the incidence of gastroschisis and exomphalos (omphalocele). DESIGN:Retrospective analysis using data from the Office of Population Censuses and Surveys (recoded to differentiate...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7062.903
更新日期:1996-10-12 00:00:00
abstract:OBJECTIVE:To accurately measure the incidence of gastric cancer among patients with gastric precancerous lesions, and to quantify the excess incidence in comparison with people with normal mucosa on endoscopy and a general population. DESIGN:Population based cohort study. SETTING:Population of Sweden using data from ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h3867
更新日期:2015-07-27 00:00:00
abstract::London's health care problems, particularly underfunding, are mirrored in other major cities in the United Kingdom and abroad. None has found the perfect solution, but the debates on the Tomlinson report provide an opportunity to review how to manage the three major areas of service provision, medical education, and r...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6871.199
更新日期:1993-01-16 00:00:00