Patients In Deprived Areas Research Articles

Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study.

Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients' views regarding online appointment booking arrangements. This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice.

Socioeconomic disparities in surgery for carotid artery disease in England.

Carotid artery disease and stroke are more prevalent in socioeconomically deprived areas. The aim was to investigate socioeconomic disparities in carotid artery disease surgery rates and in outcomes following surgery. The study used population-based ecological and cohort study designs, 31 672 census areas in England, hospital admissions from April 2006 to March 2018, the Index of Multiple Deprivation 2010 as the area-level deprivation indicator, and Poisson, logistic, and Cox regression. A total of 54 377 patients (67 per cent men) from a population aged 55 years and older of 14.7 million had carotid artery disease procedures (95 per cent carotid endarterectomy). Carotid endarterectomy rates were 116 per cent (95% c.i. 101 to 132) higher in men and 180 per cent (95% c.i. 155 to 207) higher in women aged 55-64 years in the most compared with the least socioeconomically deprived areas by quintile. However, this difference diminished and appeared to reverse with increasing age, with 24 per cent (95% c.i. 14 to 33) and 12 per cent (95% c.i. -3 to 24) lower carotid endarterectomy rates respectively in men and women aged 85 years and older in the most deprived areas. Patients in deprived areas having carotid endarterectomy were more likely to have been admitted as symptomatic emergency carotid artery disease admissions. Mortality, and a combined outcome of mortality or stroke-related re-admission, were both worse in patients living in more deprived areas and were only partially accounted for by the higher prevalence of co-morbidities. There was, however, no clear pattern of association between deprivation and elective waiting time for carotid endarterectomy. These results provide evidence of socioeconomic disparities in surgery for carotid artery disease. Clear policies are needed to address these disparities.

The effect of peer support on quality of life among type 2 diabetic patients in deprived areas in Iran: A randomized clinical trial.

BACKGROUND:Quality of life (QOL) is one of the effective factors in promoting the health of diabetic patients. In recent years, the role of peer support in the optimal management of diabetes has gained increasing attention. However, contradictory results have been reported from the effectiveness of this method. This study aimed to investigate the effect of peer support on the QOL among type 2 diabetic patients in deprived areas.MATERIALS AND METHODS:This study was a randomized clinical trial conducted on 80 patients with T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assigned into two groups of 40 patients. Intervention group received a peer Supportive-educational program for 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventory was used to collect the data. This questionnaire was completed three times at the beginning of the study, immediately after the 3-day training, and after 3 months of peer supportive intervention. The SPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations.RESULTS:There was no significant difference in mean QOL between the two groups before the intervention (P = 0.891) and immediately after the education (P = 0.076). However, after 3 months of intervention, the intervention group showed a significant improvement in mean QOL compared to those in the control group (P < 0.001).CONCLUSION:Peer support program can improve the QOL in type 2 diabetic patients in deprived areas. Therefore, this method can be recommended to improve care and educational programs in these patients.

General Practitioners' Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation.

We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings. Six hundred fifty-nine patients attending 47 general practitioners in high- and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and non-verbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods. Patients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups. Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."

Depression and multimorbidity in psychiatry and primary care.

Depression and multimorbidity in psychiatry and primary care.

'It's just a way of approaching things now': staff perspectives of an anticipatory care programme in Edinburgh.

Keep Well, an anticipatory care programme aimed at reducing health inequalities in Scotland, commenced in 2006. There is currently little evidence exploring how frontline staff respond to the delivery of anticipatory care. To understand how staff view changes in practice resulting from the implementation of Keep Well. Qualitative interviews were conducted with a purposively selected sample of 12 Keep Well staff. Data were analysed using a thematic analysis approach. Keep Well was viewed positively, especially in terms of increased knowledge and skills for staff and the benefits of a holistic health check to patients. Staff believed that Keep Well has improved their practice beyond the project. Concerns were raised, relating to potential inconveniences for patients, staff turnover, increased workload and procedures. There was a view that anticipatory care should continue to be delivered to deprived communities, provided that there are adequate resources, such as staff and funding, to do so. Keep Well staff believe that the project should continue to be offered as a 40-minute holistic health check targeted at patients in deprived areas.

Trends in the epidemiology of smoking recorded in UK general practice

Smoking represents the most important cause of avoidable morbidity and mortality in the economically developed world. The UK has recently introduced a range of initiatives aiming to reduce smoking prevalence and smoking-related health inequalities. To investigate the epidemiology of smoking in UK general practice. Cross-sectional study. A total of 525 general practices contributing to the QRESEARCH database. A dataset was extracted on 2.7 million patients around each financial year for the period 2001-2007, including, age, sex, deprivation, and smoking status. For patients newly recorded as smoking, data were extracted on receipt of smoking cessation advice and referral to stop-smoking services. Over the study period, the proportion of people with smoking status recorded increased by 32.9% (2001/2002: 46.6% to 2006/2007: 79.5%). A large overall increase in the provision of smoking cessation advice (2001/2002: 43.6% to 2006/2007: 84.0%) and referral to stop-smoking services (2001/2002: 1.0% to 2006/2007: 6.6%) was also observed. The proportion of people who smoked (with a recorded smoking status) reduced by 6.0% (2001/2002: 28.4% to 2006/2007: 22.4%). This decrease was greatest among patients in the most deprived areas (7.2%) and the youngest patients (16-25 years: 7.1%). In 2006/2007, more than twice as many patients in deprived areas smoked as those in affluent areas (most deprived: 33.8%; most affluent: 14.1%). A significant and important reduction in the number of UK smokers occurred between April 2001 and April 2007. However, although this is an improvement, comparatively high rates of smoking remain among younger adults and those who are the most socioeconomically deprived.

Equity in waiting times for two surgical specialties: a case study at a hospital in the North West of England

Reducing inequalities in access to the National Health Service is a key government priority. This study investigates the extent to which equitable access is achieved in one routinely administered hospital waiting list system. Using hospital episode statistics for one hospital in the North West of England, a retrospective study of waiting times to surgery was undertaken for two surgical specialties (Orthopaedics and Ophthalmology). Participants were 4306 waiting list patients (elective, first episodes) living within Health Authority boundaries, treated within the two specialties between 1 April 2000 and 31 March 2001. Multiple logistic regression analysis of the relationship between waiting times and age, gender, ethnicity and deprivation status was undertaken. Main outcome measures were length of waiting time between being referred to the waiting list and treatment, and odds ratios for being associated with longer than median waiting times by age, gender, ethnicity and deprivation. For ophthalmology, the median waiting time was 140 days. After adjustment, older people had an odds ratio (OR) of 1.64 (95 per cent confidence interval (CI) 1.42-1.89), patients in deprived areas an OR of 1.29 (95 per cent CI 1.08-1.55) and men an OR of 0.79 (95 per cent CI 0.68-0.92) for having longer than median waiting times. No significant association was found between waiting times and ethnicity. For orthopaedics, the median waiting time was 129 days, and there were no significant differences in waiting times according to age, gender, ethnicity or deprivation. Routine waiting list systems are not always delivered equitably. For one specialty, female, older and deprived patients were significantly more likely to experience longer than average waits. Potential explanations and implications for policy-makers are considered.

Socio‐economic status, obesity and prevalence of Type 1 and Type 2 diabetes mellitus

The influence of socio-economic status on the prevalence of Type 1 and Type 2 diabetes mellitus, and on obesity, was explored using routinely collected healthcare data for the population of Tayside, Scotland. Among 366,849 Tayside residents, 792 and 5,474 patients with Type 1 and Type 2 diabetes, respectively, were identified from a diabetes register. The Carstairs Score was used as a proxy for socio-economic status. This is a material deprivation measure derived from the UK census, using postcode data for four key variables. Odds ratios for diabetes prevalence, adjusted for age, were determined for each of six deprivation categories (1 - least deprived, 6/7 - most deprived). The mean body mass index (BMI) in each group was also determined, and the effect of deprivation category explored by analysis of covariance, adjusting for age and sex. The prevalence of Type 2 diabetes, but not Type 1 diabetes, varied by deprivation. People in deprivation category 6 and 7 were 1.6-times (95% confidence interval 1.4-1.8) more likely to have Type 2 diabetes than those least deprived. There was no relationship between deprivation and BMI in Type 1 diabetes (P = 0.36), but there was an increase in BMI with increasing deprivation in Type 2 diabetes (P < 0.001; test of linearity P < 0.001). The study confirms the relationship between deprivation and the prevalence of Type 2 diabetes. There are more obese, diabetic patients in deprived areas. They require more targeted resources and more primary prevention.