Resource allocation modelling for home-based health and social care services in areas having differential population density levels: a case study in Northern Ireland.

This project arose from deliberations within the Department of Health and Social Services (DHSS) in Northern Ireland concerning the acceptability of the revenue resource allocation methodology they were using. One problem with the method being used had been the absence of a component that adequately reflected the relative costs associated with the differential population densities of the four health boards into which the Province is divided. This study investigates a particular element of this issue, viz differences in the travelling distances and times of those health and social service professionals who provide visiting services to patients in their own homes. A modelling approach has been developed and used in conjunction with a comprehensive spatial and geographical information system for Northern Ireland. An important outcome of the study has been estimates of the targets that should be set for the annual health and social care travelling distances and times per head of population in the boards, for a range of home-based services. Also, the project has contributed to decisions made by the DHSS in Northern Ireland concerning the annual financial compensations required by boards for costs associated with their relative population densities.

Specialty location decisions in the reformed NHS: a case study.

A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of 'small' specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.

Developing GP monitoring systems guided by a soft systems approach.

This paper describes a selected aspect of a research project concerned with 'contracts and competition' in the recently reformed National Health Service. The particular feature highlighted in this paper is the central role played by the general practitioners in the health service as principal sources of the demands made on provider units (particularly hospitals) and, hence, critical determinants of volumes and costs in contracting. A practical outcome of the research has been the development of GP monitoring systems to be used by provider units particularly in the context of marketing-led referral expectations. The approach used to highlight areas of potential GP contract management and monitoring improvements has been a development of soft systems methodology.

A statistical study of factors influencing outpatient service in health districts.

This paper describes a statistical study within NHS health districts, using routinely available data, of the supply of outpatient services, the demands made on these services and the resulting balance of supply and demand. Indicators of supply have been investigated which aim to reflect the resources available within a district for outpatient services and indicators of demand have been studied which link to the number of general practitioners who are considered likely to make use of the services provided. Some preliminary analysis is attempted of relationships between the observed balance of supply and demand and the predictions based on the statistical models developed.

The relative accessibility for health districts to regionally supplied specialist services.

This paper describes a study carried out in the North Western Health Region of England where it is policy to provide access to regionally supplied specialist services on an equal basis to all component Health Districts. The results, however, suggest substantial differences in uptake depending on the proximity of the District of residence of the patient to the location of such specialist service. Throwing light on this phenomenon proved difficult because many important Regional services are hard to disentangle from the 'normal' District services with which they are organisationally linked. Also diagnostic classification schemes do not always provide a clear indication of those patients who require the super-specialist service.

Comparison of carisoprodol, butabarbital, and placebo in treatment of the low back syndrome.

A double-blind study was carried out to determine the effectiveness of a muscle relaxant, carisoprodol, in the treatment of the low back syndrome, and to test whether this drug would produce any greater effect than an active sedative control. Forty-eight Mexican migrant farm laborers with acute lumbar strain and spasm were given either carisoprodol 350 mg, butabarbital 15 mg, or placebo, four times daily for four days, and then were rated on pertinent symptoms, the degree of limitation of motion (by an objective finger-to-floor test), and overall improvement. In the 43 patients who could be statistically analyzed, carisoprodol was shown to be significantly more effective than butabarbital or placebo in producing improvement of all factors rated. This result suggests that the effects of carisoprodol are not due solely to sedative action, but are also related to its muscle relaxant activity.