Abstract:
AIMS:To evaluate the extent to which structural variation between English general practices is accounted for at higher organisational levels in the National Health Service (NHS). METHODS:We analysed data for 11 structural characteristics of all general practices in England. These included characteristics of general practitioners (GPs), the practice list and the services provided by practices. A four-level random effects model was used for analysis and components of variance were estimated at the levels of practice, primary care group (PCG), health authority and region. RESULTS:The proportion of single-handed practices ranged from 0% to 74% at PCG level and from 14% to 43% in different regions. The proportion of practices providing diabetes services ranged from 0% to 100% at PCG level and from 71% to 96% in different regions. The list size per GP ranged from 1314 to 2704 patients per GP at PCG level and from 1721 to 2225 at regional level. Across the 11 variables analysed, components of variance at general practice level accounted for between 43% and 95% of the total variance. The PCG level accounted for between 1% and 29%, the health authority level for between 2% and 15% and the regional level for between 0% and 13% of the total variance. Adjusting for an index of deprivation and the supply of GPs gave a median 8% decrease in the sum of variance components. CONCLUSION:Geographical and organisational variation in the structure of primary care services should be considered in designing studies in health systems such as the English NHS. Stratified designs may be used to increase study efficiency, but variation between areas may sometimes compromise generalisability.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Adams G,Gulliford M,Ukoumunne O,Chinn S,Campbell Mdoi
10.1258/135581903321466058subject
Has Abstractpub_date
2003-04-01 00:00:00pages
87-93issue
2eissn
1355-8196issn
1758-1060journal_volume
8pub_type
杂志文章abstract::Health services research must continually address the question: Under what conditions may data not collected specifically for research, such as primary medical data, be re-used for research without compromising the privacy of the data-subjects? For secondary use of data in research there are basically three options. O...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581903766468800
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVES:To explore the relationship between ethnicity, socioeconomic deprivation and utilization of general practice. METHODS:Data routinely collected by New Zealand general practices in 2001 were analysed using generalized linear regression. RESULTS:The mean number of doctor consultations for registered individua...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906777641721
更新日期:2006-07-01 00:00:00
abstract::It is important to include non English speakers in health services research to ensure not only the generalisability of findings but also to address health inequalities and promote social justice. One approach is to use interpreters but there is little guidance for working with an interpreter in interviews. Involving a...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/JHSRP.2012.012003
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patt...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581905774414259
更新日期:2005-10-01 00:00:00
abstract::This paper deals with three concerns about the evaluative framework that is currently dominant within health economics. These concerns are: that the evaluative framework is concerned entirely with health; that the evaluative framework has an individualistic focus on patients alone; and that the methods used to estimat...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008024
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:To explore some of the impacts of star performance ratings in acute hospital trusts in England. METHODS:A multiple case study design was used which incorporated purposeful sampling of 'low' and 'high' performing trusts using the star rating system. In each case study site, data collection comprised semi-stru...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960501000106
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVE:The effects of demographic, locational and socio-economic disadvantage, and the influence of private health care on five-year mortality rates in patients with lung cancer or after breast cancer surgery in Western Australia were examined. METHODS:The Western Australian Record Linkage Project was used to extra...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819042248116
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVES:To understand the challenges and opportunities associated with the introduction of assistant practitioner (AP) roles supporting the work of ward-based registered nurses (RNs) in National Health Service (NHS) acute hospital trusts in England. METHODS:Three case studies of NHS acute hospital trusts. This pape...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2011.010106
更新日期:2011-04-01 00:00:00
abstract::This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive an...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/135581969700200310
更新日期:1997-07-01 00:00:00
abstract::'Knowledge transfer' has become established as shorthand for a wide variety of activities linking the production of academic knowledge to the potential use of such knowledge in non-academic environments. While welcoming the attention now being paid to non-academic applications of social research, we contend that terms...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
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更新日期:2008-07-01 00:00:00
abstract:OBJECTIVES:This paper focuses upon health status, need for care, and use of health care from 1994/95 to 2000/01 in the Canadian foreign-born population. METHODS:Using Statistics Canada's longitudinal National Population Health Survey, descriptive and survival analyses are used to explore immigrant health status and he...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819053559074
更新日期:2005-04-01 00:00:00
abstract::Objectives To investigate the effects of four factors on perceptions of fairness in access to outpatient services: proportions of walk-in versus scheduled registration, consultation queues, regulations for late patients and particular categories of patients getting better access. Methods A total of 124 young adults we...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819617725546
更新日期:2018-01-01 00:00:00
abstract::The study, first published in 2003, looks at the root causes of adverse events and near misses in obstetrics at seven hospital maternity units by interviewing 93 members of staff, identifying the areas of mismanagement in each case and thematically analysing them. ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2009.09s106
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:Effective use of staff is a major aim in all health-care systems both to maximize their impact and to minimize costs. In England, a few general practitioners (GPs) have been recruiting physician assistants (PAs) to work in their practices, independent of any pilot schemes. Our objective was to study the motiv...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.010061
更新日期:2011-04-01 00:00:00
abstract::Understanding the environmental and behavioural predictors of wellbeing is a key driver of health and social care research. Research set in the social world examines the relationships between behavioural, cognitive, emotional and environmental factors, linking these to disease or social ills with the aim of providing ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.010016
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVES:To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. METHODS:Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1177/135581960000500203
更新日期:2000-04-01 00:00:00
abstract::The purpose of this paper is to expand understanding of academic-practitioner knowledge-sharing in the service of enhanced knowledge creation in health care. To this end, we describe the tacit and explicit knowledge of academics and practitioners and how this knowledge exists within their communities of practice. We a...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581903322405199
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVES:To investigate the organisational factors that impede or facilitate transition of young people from child and adolescent (CAMHS) to adult mental health services (AMHS). METHODS:Thirty-four semi-structured interviews were conducted with health and social care professionals working in child and adult services...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819614527439
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVES:To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. METHODS:We estimated the annual costs per patient (HIV clinic visits and eit...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613508176
更新日期:2014-07-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969700200406
更新日期:1997-10-01 00:00:00
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journal_title:Journal of health services research & policy
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journal_title:Journal of health services research & policy
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abstract::Patients are increasingly using the internet to access information on health care and services, as well as writing reviews of their own experiences. With patient choice increasing in many health systems, payers, purchasers and providers are attempting to take control of this trend by designing and managing their own p...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.010010
更新日期:2011-04-01 00:00:00
abstract::We summarise and evaluate Harris' criticisms of cost-effectiveness analysis (CEA) and the alternative processes he commends to health care decision makers. In contrast to CEA, Harris' asserts that individuals have a right to life-saving treatment that cannot be denied on the basis of their capacity to benefit. We conc...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2012.011057
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVES:To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. METHODS:Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privatel...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400204
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVES:The nine NIHR CLAHRCs are collaborations between universities and local NHS organizations that seek to improve patient outcomes through the conduct and application of applied health research. The theoretical and practical context within which the CLAHRCs were set up was characterized by a considerable degree...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613499903
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVES:To explore patients' and carers' views on what constitutes high-quality communication and information provision during diagnostic assessment in memory clinic services in three areas of England. METHODS:Interviews with 27 people with cognitive impairment (13 with confirmed dementia) and 26 carers (20 matched...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613479945
更新日期:2013-07-01 00:00:00
abstract::Discussion of unanticipated problems in care with patients and their families ('open disclosure') is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819614558100
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:Cost-utility analysis is gaining importance as a tool for setting priorities in health care. The approach requires quality-of-life weights on a scale from 0.00 (corresponding to death) to 1.00 (corresponding to perfect health). Different methods and perspectives of the evaluators tend to give different result...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/135581904322716111
更新日期:2004-01-01 00:00:00
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journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2009.009024
更新日期:2010-07-01 00:00:00