Standardization of health assessments for patients aged 75 years and over: 3 years' experience in the Forth Valley Health Board area.

BACKGROUND: The new contract for general practitioners (GPs) was introduced in 1990. This required all GPs to offer their patients aged 75 years of over an annual assessment. AIM: The study aimed to determine if 3 years' experience had resulted in standardization of the way in which health assessments for patients aged 75 years and over are carried out. METHOD: The study was carried out in 1993. Questionnaires were sent to the principal partners of all 55 general practices in the Forth Valley Health Board (FVHB) area. The main outcome measures were the fulfilment of contractual requirements and standardization of the health assessment process. RESULTS: Completed questionnaires were returned by 49 practices (89%) Eighty per cent (39 practices) had drawn up their own assessment programme in 1990. Responsibility for assessments was most often (41 practices) shared between different members of the primary care team (84%). Although most practices satisfied contractual requirements, there were wide variations in approach, potentially influencing outcome. CONCLUSION: Despite three years' experience, no standardized approach to the health assessment of patients aged 75 years and over has been developed. Purchasers of health care require information on the needs of their client population, and this should be available in an accessible, standardized form. There is an urgent need for a review of the way in which the 1990 contract has been implemented to standardize health assessments and improve effectiveness in meeting its original aims.

Where needs and demands diverge: health promotion in primary care.

UNLABELLED: This study reviews Forth Valley Health Board's 'Be Better Hearted' coronary heart disease health promotion programme by analysis of data routinely collected between 1988 and 1993. Associations between socioeconomic deprivation, prevalence of risk factors, and attendance at health promotion clinics are of particular interest in relation to future health promotion strategy. METHOD: A study was made of computerised records of 20,053 baseline risk factor assessments in the primary care setting and 1,058 follow-up attendances. A method of classification by socioeconomic status was applied. RESULTS: Baseline data provided a profile of new attenders over time with regard to age, gender, risk factors and socioeconomic status but lack of follow-up information prevented evaluation of the outcome of the programme. There was a statistically significant association between prevalence of risk factors (such as smoking, obesity and lack of exercise) and deprivation. In the most affluent areas 19.0% of the target population participated in the programme; in deprived areas this fell to 10.7%. There was thus a failure to involve those most in need of health promotion. CONCLUSION: If equity in provision of health promotion is to be achieved, measures must be taken locally and nationally to reach deprived sections of the population. In this type of health promotion programme, baseline and follow-up information should be entered on computer at the clinical locus to enable monitoring of outcome. These conclusions are particularly relevant to the national arrangements for health promotion in primary care which were introduced in July 1993.

Perceived usefulness of the Director of Public Health Annual Report: a consumer survey.

The Annual Report of the Director of Public Health for Forth Valley was evaluated in terms of its usefulness as perceived by recipients. Six months after publication, more than half had retained their copy and a similar proportion had made use of it or anticipated using it in the coming year. Its main use was as a reference. The Report had least impact upon Consultants and General Practitioners.