Impact of peer support on inpatient and outpatient payments among people with Type 2 diabetes: a prospective cohort study.

AIM: To investigate the impact of a low-cost diabetes peer-support intervention, aimed at reducing inpatient and outpatient care utilization and healthcare payments, by conducting a cohort study that followed up a randomized controlled trial. METHODS: A total of 1121 adults with Type 2 diabetes were recruited through general practices in Cambridgeshire and Hertfordshire, UK, and were followed up for 3.25 financial years after 8-12 months of one-to-one, group or combined diabetes peer support and usual care. Use of, and payments for inpatient and outpatient services were fully recorded in the follow-up. Adjusted mean inpatient and outpatient payments per person were estimated using a two-part model after adjusting for baseline characteristics. RESULTS: The mean age of the recruited adults was 65.6±11.4 years, 60.4% were male, and 16.8% were insulin-treated. Compared with the control group, less healthcare utilization (especially non-elective inpatient care and outpatient consultations) was observed in each of the intervention groups, particularly the combined intervention group. Over the course of 3.25 financial years, significant reductions of 41% (£909.20 per head) were observed for overall inpatient payments (P<0.0001), 51% (£514.67 per head) for non-elective inpatient payments (P=0.005) in the combined intervention group, and 34% (£413.30 per head) and 32% (£388.99 per head) for elective inpatient payments in the one-to-one (P=0.029) and combined intervention (P=0.048) groups, respectively. CONCLUSIONS: Type 2 diabetes peer support, whether delivered using a one-to-one, group or combined approach was associated with reduced inpatient care utilization (particularly non-elective admissions) and payments over 3.25 years.

GPs views and understanding of PSA testing, screening and early detection; survey.

BACKGROUND: There is currently no national prostate cancer screening programme in the UK. However, patients 50 years and older are entitled to a prostate specific antigen (PSA) test, if informed on the advantages and disadvantages of testing and their risk of cancer. The Prostate Cancer Risk Management Programme (PCRMP) provides this guidance. AIM: The aim of this study was to access GPs' views and understanding of PSA testing, prostate cancer screening and early detection. METHOD: A total of 708 questionnaires were returned by GPs across two English regions in 2013 and the GP questionnaire responses were quantitatively analysed. RESULTS: In the 699 completed questionnaires, the majority of GPs were well informed about PSA testing, screening and early detection. Only 32% used guidelines for referral, 14% knew all age-specific PSA referral levels, 71% that Black men have a higher prostate cancer risk than White men (22% correctly answered threefold increase) and 82% that family history is a risk factor. A further 78% thought electronic prompts during consultation would encourage PCRMP guideline usage and 75% had never been offered a PSA test and prostate cancer educational course, of which 73% would like to attend a course. Only 23% were aware of the latest PSA screening evidence and 94% would like an update. CONCLUSIONS: Participating GPs seem to be well informed but need more information and tools to help follow recommended guidance. In particular, increased awareness of PCRMP guidelines especially by automated methods, further educational courses and evidence updates would be beneficial.

Family support in general practice.

At a time when social services are overburdened in Britain, family support in general practice offers one way to fill the gap. In the Well Family Project, a 'family support coordinator' worked within a general practice in Hackney, London. In the first eighteen months she saw 113 clients. Evaluation was by semistructured interviews with a sample of these clients and with professional workers. Comments from those interviewed indicate that the family support was valued. The general practice base was convenient and non-stigmatizing. By adopting a proactive approach, the project was able to work with clients who had previously 'slipped through the net'. Some of the professionals interviewed would have liked to provide the same help, but were unable to do so because of time and other constraints. Family support provided through general practice was well received by vulnerable families. Although there was overlap with the remit of health visitors and social workers, the protected time and the independence of the coordinator enabled clients to obtain the help they wanted. The replicability of this strategy now needs to be assessed.

Purchasing for all: an alternative to fundholding.

OBJECTIVE: To evaluate general practitioner participation in a district health authority's purchasing work. DESIGN: Questionnaire study of 131 Hackney general practitioners and 33 senior health service managers; review of the minutes of 28 meetings of the Hackney General Practitioners' Forum and the contract between City and Hackney Health Authority and the St Bartholomew's NHS Trust. SETTING: Hackney General Practitioners' Forum. MAIN OUTCOME MEASURES: General practitioners' and managers' perceptions of how representative and effective the general practitioners' forum is; proportion of new quality targets and service developments contributed by general practitioners; main issues discussed by the forum and impact on district health authority policy. RESULTS: 99 (76%) general practitioners and 27 (82%) managers responded. Both groups perceived the forum as representative. 92% (24/26) of the managers thought the forum was effective but only 74% (70/95) of general practitioners did so, largely because some doubted that the forum was listened to 75% (103/138) of quality targets and 55% (16/29) of service developments planned in the 1993-4 contract were contributed by general practitioners. They also lobbied successfully for more resources for urology and community mental health services. CONCLUSIONS: Input into commissioning via a general practitioners' forum can be both representative and effective. General practitioners need to work closely to achieve a consensus and those involved need administrative support. The relation between general practice and public health medicine needs to be strengthened.

Mothers' attitudes to and experience of breast feeding: a primary care study.

This study investigated the attitudes to breast feeding of women registered with 24 general practitioners in Nottingham. A total of 514 women were interviewed in the antenatal period and then followed up at six weeks and six months after the birth of their child. Seventy per cent of the women planned to breast feed their baby, 23% planned to bottle feed and 7% were undecided. Only 26 women changed their plans. Although 73% of the women interviewed began breast feeding, this had fallen to 49% by six weeks and 26% by six months. Logistic regression analysis showed that multiparae who had bottle fed or stopped breast feeding their previous child during the first six weeks were 5.15 times more likely to stop breast feeding in the first six weeks, than those who had breast fed their previous child for six weeks or more. Primiparae in social classes 3M, 4 or 5 or who were unemployed were 3.68 times more likely to stop than women in higher social classes, while those who said they had considered bottle feeding were 2.40 times more likely to stop. Most women gave an inadequate milk supply as a reason for stopping, but sore nipples were also a problem in the first six weeks. Of all the women who had started breast feeding 46% felt they did not have enough milk at some stage and despite the finding that 49% of those who sought advice from a health professional were advised to feed more often, 42% said they had been advised to give bottle feeds.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient choice in a practice with men and women general practitioners.

This study investigated the distribution of workload between men and women doctors in a south London practice. Of 909 attending patients aged 15 years and over, 611 were women and 48% of these consulted a woman doctor. In comparison, only 27% of the 298 men consulted a woman doctor. Twenty nine per cent of the 105 women who gave a reason for choosing a woman doctor said they had done so because of her sex. Multiple logistic regression was used to assess the relative importance of having a general preference for a woman doctor or of consulting about a problem related to sex in predicting the likelihood of a woman consulting a woman doctor. This showed that preference was 2.3 times as important as problem type in predicting this. This suggests that woman's demand for women doctors in general practice extends beyond family planning and well woman clinics. The implications of this for practice organization are discussed.

Ward meetings: a forum for patients' concerns.

A series of meetings between patients and staff were held on two general medical wards to discuss the concerns of patients. Issues ranged from the quality of hospital food, ward facilities, and visiting arrangements to the medical and nursing care provided and patients' views on medical students. Most issues were raised by the patients themselves and the outcome was either acceptance or rejection of a suggestion, an explanation by the staff, or a general discussion if a specific decision was inappropriate. Most staff and patients considered the meetings to be valuable. Ward meetings thus seem to provide a way of making hospitals more responsive to patients' concerns.

Patient participation in primary health care.

Patient participation groups have been established in about 20 practices, six of which were visited. They did not conform to a particular model but each had adapted to local circumstances. As well as giving patients a say in the practice, they were involved in health education, voluntary work, and campaigns for better secondary care facilities, although these activities were influenced by the way the groups were elected. The emphasis was on participation rather than patient power and their constructive approach to improve services made patient participation a valuable innovation.