Abstract:
OBJECTIVES:To investigate whether the rate of spend on child and adolescent mental health is influenced by demand for other competing services in local commissioning decisions. DESIGN:Analysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need. SETTING:Local commissioning decisions in the National Health Service. PARTICIPANTS:Commissioning of health services across 209 CCGs. MAIN OUTCOME MEASURES:Association between the rate of child and adolescent mental health spend and demand for child and adolescent mental health services (CAMHS), adult mental health services and physical health services after adjusting for confounding factors. RESULTS:An additional percentage point in the proportion of children in care is associated with 4% higher child and young person mental health (CYP MH) spend per person aged 0-18 (ratio of means: 1.04; 95% CI 1.00 to 1.07). Spending £100 more on physical health services was associated with 9% lower spend in CYP MH per person aged 0-18 (ratio of means: 0.91; 95% CI 0.84 to 0.99). CONCLUSIONS:Healthcare commissioners in England face a challenge in balancing competing needs. This paper contributes to our understanding of this by quantifying the possible extent of the trade-off between physical health and CYP MH when allocating budgets. Any attempt to explain the variation in CAMHS spend must also take account of demand for other services.
journal_name
BMJ Openjournal_title
BMJ openauthors
Rocks S,Fazel M,Tsiachristas Adoi
10.1136/bmjopen-2019-030011subject
Has Abstractpub_date
2019-10-07 00:00:00pages
e030011issue
10issn
2044-6055pii
bmjopen-2019-030011journal_volume
9pub_type
杂志文章相关文献
BMJ Open文献大全abstract:OBJECTIVE:Older patients with hip fractures who are undergoing surgery are at high risk of significant mortality and morbidity including postoperative delirium. It is unclear whether different types of anaesthesia may reduce the incidence of postoperative delirium. This systematic review will investigate the impact of ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-020757
更新日期:2018-12-04 00:00:00
abstract:INTRODUCTION:Hearing loss is a common chronic problem which can be effectively managed with hearing devices. At present, only a limited number of people with hearing loss use hearing aids (HAs) and cochlear implants (CIs) to improve hearing and sound quality and enhance quality of life. Clinical equipoise, by which we ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-030100
更新日期:2019-09-08 00:00:00
abstract:INTRODUCTION:Clinical depression is a substantial problem among adolescents, increasing significantly at about age 15 years. It causes impairment in social, academic and familial relationships, as well as ongoing cognitive and emotional difficulties for the individual. A study in Iceland demonstrated that a cognitive-b...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2020-040374
更新日期:2021-01-22 00:00:00
abstract:OBJECTIVES:To analyse free-text responses from the first Scottish Cancer Patient Experience Survey (SCPES) to understand patients' experiences of care, identify valued aspects and areas for improvement. DESIGN:Inductive thematic analysis of seven free-text comment boxes covering all stages of the cancer experience, fr...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015726
更新日期:2017-06-15 00:00:00
abstract:INTRODUCTION:Ageing--along with its associated physiological and pathological changes--places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all popula...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-010989
更新日期:2016-03-24 00:00:00
abstract:INTRODUCTION:Despite the strong relationship between smoking and health-related consequences, very few smokers quit. Heavy drinking is a significant risk factor for health consequences, and is implicated in persistent smoking and less success at quitting smoking. Self-efficacy (SE) to abstain from smoking is an importa...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-007046
更新日期:2015-01-06 00:00:00
abstract:OBJECTIVE:To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. DESIGN:A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. SETTING:The second...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-016845
更新日期:2017-10-15 00:00:00
abstract:OBJECTIVES:Falls are among the major external causes of unintentional injury and injury-related mortality in the elderly. The aim of this study was to compare the patterns of unintentional fall-related mortalities in two countries with different demographic structure: Slovakia and Austria in 2003-2010. METHODS:A study...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2015-008672
更新日期:2015-08-12 00:00:00
abstract:OBJECTIVE:A prospective evaluation of the effect of 2012 point-of-sale (PoS) display ban in supermarkets in England on perceived exposure to PoS displays, and on changes in susceptibility and smoking uptake among young people. DESIGN:Cohort study. SETTINGS:Seven schools in Nottinghamshire, England. PARTICIPANTS:1035...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2016-012451
更新日期:2017-01-23 00:00:00
abstract:OBJECTIVES:To define the core competencies essential for specialist training in neurocritical care in China. DESIGN:Modified Delphi method and nominal group (NG) technique. SETTING:National. PARTICIPANTS:A total of 1094 respondents from 33 provinces in China participated in the online survey. A NG of 11 members was ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033441
更新日期:2020-01-06 00:00:00
abstract:INTRODUCTION:Musculoskeletal deformities and gait deviations are common features in ambulatory cerebral palsy (CP). Deformity correction through lower limb orthopaedic surgery is the standard form of care aimed at improving or preserving motor function. Current research on CP care does not always take into account indi...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-034744
更新日期:2020-03-04 00:00:00
abstract:INTRODUCTION:Drug-resistant tuberculosis (TB) is a global concern. The proper diagnosis and management of drug-resistant TB are critical for improving treatment outcome. Molecular-based genotypic drug-susceptibility testing (DST) was developed to identify drug-resistant TB; however, discordant results from phenotypic a...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2017-021235
更新日期:2018-10-10 00:00:00
abstract:OBJECTIVES:To understand how the uptake of an extended primary care service in the evenings and weekend varied by day of week and over time. Secondary objectives were to understand patient demographics of users of the service and how these varied by type of appointment and to core hour users. DESIGN:Observational stud...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-028138
更新日期:2019-09-05 00:00:00
abstract:BACKGROUND:Prostate cancer incidence varies internationally largely attributable to differences in prostate-specific antigen (PSA) use. The aim of this study was to provide the most recent detailed international epidemiological comparison of prostate cancer incidence and mortality in six north-eastern European countrie...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-031856
更新日期:2019-10-09 00:00:00
abstract:BACKGROUND:Several studies have shown an association between oral diseases and chronic kidney disease (CKD), and regular oral care may be an important strategy for reducing the burden of CKD. The objective of this study was therefore to evaluate the association between dental and periodontal diseases in Thai patients w...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-011836
更新日期:2016-07-27 00:00:00
abstract:OBJECTIVES:Data linkage combines information from several clinical data sets. The authors examined whether coding inconsistencies for cardiovascular disease between components of linked data sets result in differences in apparent population characteristics. DESIGN:Retrospective cohort study. SETTING:Routine primary c...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2011-000723
更新日期:2012-04-13 00:00:00
abstract:INTRODUCTION:Chronic thoracic aortic aneurysm (CTAA) affecting the arch or descending aorta is an indolent but life-threatening condition with a rising prevalence as the UK population ages. Treatment may be in the form of open surgical repair (OSR) surgery, endovascular stent grafting (ESG) or best medical therapy (BMT...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2015-008147
更新日期:2015-06-02 00:00:00
abstract:INTRODUCTION:Osteoarthritis of the trapeziometacarpal joint affects approximately 10%-25% of women, especially those who are postmenopausal. It may result in thumb dysfunction. Among the treatments, intra-articular injections of corticosteroid (CS) and hyaluronic acid (HA) are both effective and recommended. However, c...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022553
更新日期:2019-01-09 00:00:00
abstract:INTRODUCTION:Although shortcomings in clinician-family communication and decision making for incapacitated, critically ill patients are common, there are few rigorously tested interventions to improve outcomes. In this manuscript, we present our methodology for the Pairing Re-engineered Intensive Care Unit Teams with N...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2019-033521
更新日期:2020-03-29 00:00:00
abstract:INTRODUCTION:Chronic lower back pain (CLBP) is a major healthcare problem with wide ranging effects. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions that identify biopsychosocial barriers to recovery have been observed to lead to successfully reduc...
journal_title:BMJ open
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjopen-2015-010407
更新日期:2016-05-26 00:00:00
abstract:OBJECTIVE:To assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children. DESIGN:Systematic review. DATA SOURCES:B...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-022105
更新日期:2019-05-05 00:00:00
abstract:INTRODUCTION:Sarcomas are rare tumours of connective tissue. The exact overall incidence of sarcomas is unknown due to diagnostic difficulties and the various histological subtypes (over 80 subtypes). However, the apparent increasing incidence of sarcomas suggests environmental causes such as pesticides. Except for som...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2019-030013
更新日期:2019-06-18 00:00:00
abstract:OBJECTIVES:To investigate the prognostic value of the neurocognitive status measured by screening instruments, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), individually and in combination with the stroke severity scale, the National Institute of Health Stroke Scale (NIHSS), obtaine...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2013-003105
更新日期:2013-09-03 00:00:00
abstract:OBJECTIVES:To evaluate the effectiveness of varenicline for smoking cessation in Chinese smokers in a real world cessation clinic practice. DESIGN:A prospective observational study. SETTING:Beijing, China. PARTICIPANTS:A total of 924 smokers (883 men and 41 women) who attended a smoking cessation clinic of a large g...
journal_title:BMJ open
pub_type: 临床试验,杂志文章
doi:10.1136/bmjopen-2015-009381
更新日期:2016-01-06 00:00:00
abstract:OBJECTIVE:To determine factors and outcomes associated with ultra-early surgery for poor-grade aneurysmal subarachnoid haemorrhage (aSAH). DESIGN:A multicentre retrospective analysis, observational study. SETTING:High-volume teaching hospitals (more than 150 aSAH cases per year). PARTICIPANTS:118 patients with World...
journal_title:BMJ open
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjopen-2014-007410
更新日期:2015-04-15 00:00:00
abstract:OBJECTIVE:To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. METHODS:CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-015285
更新日期:2017-10-05 00:00:00
abstract:OBJECTIVES:To establish the prevalence and correlates of continuum beliefs for five mental illnesses in a multiethnic population and to explore its association with stigma. DESIGN:A community-based, cross-sectional study. SETTING:A national study in a multiethnic Asian country. PARTICIPANTS:A comprehensive study of ...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2016-014993
更新日期:2017-04-05 00:00:00
abstract:OBJECTIVES:Accurate assessment of cartilage status is increasingly becoming important to clinicians for offering joint preservation surgeries versus joint replacements. The goal of this study was to evaluate the validity of three-dimensional (3D), gradient-echo (GRE)-based T2* and T1Gd mapping for the assessment of var...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2014-006895
更新日期:2015-02-09 00:00:00
abstract:OBJECTIVE:We examined the association of different chronic physical and mental conditions, individually or comorbidly on health-related quality of life (QoL) in Chinese children aged ≤14 years in Hong Kong. DESIGN:Population-based cross-sectional survey. PARTICIPANTS:Approximately 7500 Chinese children aged <14 years...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2012-001183
更新日期:2013-01-03 00:00:00
abstract:INTRODUCTION:Chronic venous insufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%-2% of adults in the USA. Why some develop VLU and others do not is unclear. VLU have a significant impact on quality of life and are extremely co...
journal_title:BMJ open
pub_type: 杂志文章
doi:10.1136/bmjopen-2018-023313
更新日期:2019-01-03 00:00:00