Comparison of ward population estimates from FHSA patient registers with the 1991 Census.

"Postcode addresses from National Health Service patient registers for Norfolk and Suffolk [counties in England] current on census day 1991 were assigned to census wards, and estimates of populations in wards were produced for the total population and for twelve age-sex groups. These were compared with adjusted counts of usual residents from the 1991 Census." The results indicate that family health service authority registers "are an acceptable alternative to the census for population estimation purposes. This supports recent arguments for wider use of population registers and suggests that they may be particularly valuable as a source of intercensal information."

Evaluation of methods for calculating census health indicators for GP practices.

The patients registered with a general practice are usually spread over many census areas and overlap with the distribution of neighbouring practices, so a validated method of aggregating census data to describe the characteristics of practice patients is required. Four methods were used to provide estimates of the percentage of patients aged 75 years and over from census data for 81 practices in Suffolk, England, and these were compared with values derived from the FHSA patient register. Census values for practice areas produced better estimates than those based on the location of the surgery, but the best methods were based on patient-weighted averages of ward and enumeration district data. The finer geographical detail of enumeration districts did not produce substantially more accurate estimates than the ward-level data: both gave estimates with limits of agreement within 2% of the patient register values. Errors in the census, errors in patient registers and selective geographical distributions of practice patients prevent close matching of census and register measures, but two of the methods tested produced estimates that allow broad comparisons between practices.

Proverb familiarity and the mental status examination.

Asking patients to interpret proverbs is a traditional method of assessing abstract thinking ability. Familiarity with a proverb increases the likelihood of interpreting it correctly. Differences in proverb familiarity among patients could lead clinicians to incorrectly conclude that a patient is thinking concretely, and thus to underestimate the patient's cognitive ability. Clinicians should be aware of this possibility when assessing patients from different racial and gender groups. The authors surveyed 229 Afro-American and 104 Caucasian high school students to determine their familiarity with 25 proverbs. Thirty-seven clinicians were also asked to rate their patients' familiarity with the same proverbs. The authors found no differences in proverb familiarity between the black and white students or the male and female students. Clinicians' beliefs about proverb familiarity in their patients were found to be inaccurate.

Role of branch surgeries in a rural area.

Surveys of general practitioners and rural residents were conducted in Norfolk to establish the characteristics of branch surgeries in the district and the patients who use them. The branch surgeries tend to serve an unrepresentative section of patients, predominantly those disadvantaged both in health and personal mobility-those from manual social classes, the elderly and those without cars. While doctors and patients were agreed that lower standards of care are provided in most branch surgeries compared with main surgeries, the evidence suggests that branch surgeries nevertheless meet a social need.

The effects of accessibility on general practitioner consultations, out-patient attendances and in-patient admissions in Norfolk, England.

A social survey was conducted to investigate the effects of accessibility on contacts with general practitioners and hospitals under the National Health Service in the predominantly rural county of Norfolk. Random samples of adults were taken close to hospital and general practitioner services in the city of Norwich, in villages close to Norwich with and without a general practitioner surgery and in villages relatively remote from the city with and without a surgery. General practitioner consultation rates, out-patient attendance rates and in-patient admissions were all found to decline with decreasing accessibility. For people with a long-standing illness, the main difference in rates was between urban and rural areas. The groups most affected in the rural areas were those with the highest relative need of health care. Their counterparts in the city used the health services much more. For the larger section of the sample, those with no long-standing illness, the most significant differences were between the various rural locations. Here, both distance to a surgery and distance to the city hospitals were associated with decreasing consultation, out-patient and in-patient rates. The main trend was of young mobile people with high expectations in places with readily accessible health services using those services more than would be expected from their usage rates elsewhere. There was also evidence among the people with no long-standing illness of less prosperous sub-groups being affected by remoteness at the out-patient stage.