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3. Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice

Author

Baker, R, Reddish, S, Robertson, N, Hearnshaw, H, and Jones, B

Subjects
Research Article
Abstract

BACKGROUND: Various methods are available for implementing change in the clinical behaviour of general practitioners (GPs). Although passive dissemination of information is generally ineffective, other methods can be variably effective. Few studies have investigated the impact of tailored methods. AIM: To determine whether methods tailored to overcome obstacles to change using psychological theories are more effective than dissemination alone in the implementation of guidelines for depression among GPs. DESIGN OF STUDY: Randomised controlled trial. SETTING: Sixty general practices in England; 30 GPs in the control group, 34 in the intervention group. METHOD: Practitioners identified patients presenting with depression before and after the implementation of guidelines (control group n = 192 in the first data collection, n = 181 in the second; intervention group n = 210 in the first data collection and n = 197 in the second). The main outcome measures were: record of adherence to guideline recommendations in clinical records; proportion of patients with Beck Depression Inventory (BDI) score less than 11 at 16 weeks after diagnosis. RESULTS: In comparison with the control group, in the group of GPs receiving tailored implementation, there were increases in the proportions of patients assessed for suicide risk. In the intervention group, the proportion of patients with BDI scores of less than 11 at 16 weeks increased. CONCLUSION: Obstacles to implementation can be identified and strategies tailored to address them. The findings indicate a new approach for research to understand and develop methods of implementation.

Published
2001

4. Patients in Europe evaluate general practice care: an international comparison

Author

Grol, R., Michel Wensing, Mainz, J., Jung, Hp, Ferreira, P., Hearnshaw, H., Hjortdahl, P., Olesen, F., Reis, S., Ribacke, M., and Szecsenyi, J.

Subjects
Male, Patient evaluations, International comparisons, International Cooperation, Culture, Kwaliteitsoordelen van chronisch zieken over de huisartsenzorg, Middle Aged, Europe, Patient Satisfaction, Surveys and Questionnaires, Quality judgements of chronical patients about general practice care, Practice Guidelines as Topic, Humans, Female, General practice, Family Practice, Delivery of Health Care, Research Article
Abstract

Background. Patients’ evaluations can be used to improve health care and compare general practice in different health systems. Aim. To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision. Method. An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP. Results. The patient sample included 17 391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed care as good or excellent; in particular, keeping records confidential, GP listening to patients, time during consultations, and quick services in case of urgent problems were evaluated positively. Patients were relatively negative about organisational aspects of care. The evaluations in different countries were largely similar, with some interesting differences; for instance, service and organisational aspects were evaluated more positively in fee-for-service health systems. Conclusions. Patients in Europe are positive about general practice but improvements in practice management in some countries are requested. More research is needed to study the complex field of differences in expectations and evaluations between countries with different health systems.

Published
2001

5. A survey of audit activity in general practice

Author

Hearnshaw, H, Baker, R, and Cooper, A

Subjects
Medical Audit, Wales, England, health services administration, Humans, Family Practice, Research Article
Abstract

BACKGROUND: Since 1991, all general practices have been encouraged to undertake clinical audit. Audit groups report that participation is high, and some local surveys have been undertaken, but no detailed national survey has been reported. AIM: To determine audit activities in general practices and the perceptions of general practitioners (GPs) regarding the future of clinical audit in primary care. METHOD: A questionnaire on audit activities was sent to 707 practices from 18 medical audit advisory group areas. The audit groups had been ranked by annual funding from 1992 to 1995. Six groups were selected at random from the top, middle, and lowest thirds of this rank order. RESULTS: A total of 428 (60.5%) usable responses were received. Overall, 346 (85%) responders reported 125.7 audits from the previous year with a median of three audits per practice. There was no correlation between the number of audits reported and the funding per GP for the medical audit advisory group. Of 997 audits described in detail, changes were reported as 'not needed' in 220 (22%), 'not made' in 142 (14%), 'made' in 439 (44%), and 'made and remeasured' in 196 (20%). Thus, 635 (64%) audits were reported to have led to changes. Some 853 (81%) of the topics identified were on clinical care. Responders made 242 (42%) positive comments on the future of clinical audit in primary care, and 152 (26%) negative views were recorded. CONCLUSION: The level of audit activity in general practice is reasonably high, and most of the audits result in change. The number of audits per practice seems to be independent of the level of funding that the medical audit advisory group has received. Although there is room for improvement in the levels of effective audit activity in general practice, continued support by the professionally led audit groups could enable all practices to undertake effective audit that leads to improvement in patient care.

Published
1998

7. Patient satisfaction with availability of general practice: an international comparison.

Author

Wensing, M.J.P., Vedsted, P., Kersnik, J., Peersman, W., Klingenberg, A., Hearnshaw, H., Hjortdahl, P., Paulus, D., Kunzi, B., Mendive, J., Grol, R.P.T.M., Wensing, M.J.P., Vedsted, P., Kersnik, J., Peersman, W., Klingenberg, A., Hearnshaw, H., Hjortdahl, P., Paulus, D., Kunzi, B., Mendive, J., and Grol, R.P.T.M.

Abstract

Item does not contain fulltext, OBJECTIVE: To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice. DESIGN: Written surveys completed by patients. SETTING: General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia and Spain. STUDY PARTICIPANTS: 15996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). MAIN MEASURES: The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. RESULTS: Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. CONCLUSION: Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved.

Published
2002

11. Patients in Europe evaluate general practice care: an international comparison

Author

Grol, R.P.T.M., Wensing, M.J.P., Mainz, J., Jung, H.P., Ferreira, P.A., Hearnshaw, H., Hjortdahl, P., Olesen, F., Reis, S., Ribacke, M., Szecsenyi, J., Grol, R.P.T.M., Wensing, M.J.P., Mainz, J., Jung, H.P., Ferreira, P.A., Hearnshaw, H., Hjortdahl, P., Olesen, F., Reis, S., Ribacke, M., and Szecsenyi, J.

Abstract

Item does not contain fulltext

Published
2000

13. Patients' priorities with respect to general practice care: an international comparison

Author

Grol, R.P.T.M., Wensing, M.J.P., Mainz, J., Ferreira, P.A., Hearnshaw, H., Hjortdahl, P., Olesen, F., Ribacke, M., Spenser, T., Szécsényi, J., Grol, R.P.T.M., Wensing, M.J.P., Mainz, J., Ferreira, P.A., Hearnshaw, H., Hjortdahl, P., Olesen, F., Ribacke, M., Spenser, T., and Szécsényi, J.

Abstract

Item does not contain fulltext

Published
1999

16. General practice care and patients' priorities in Europe: an international comparison

Author

Wensing, M.J.P., Mainz, J., Ferreira, P.A., Hearnshaw, H., Hjortdahl, P., Olesen, F., Reis, S., Ribacke, M., Szecsenyi, J., Grol, R.P.T.M., Wensing, M.J.P., Mainz, J., Ferreira, P.A., Hearnshaw, H., Hjortdahl, P., Olesen, F., Reis, S., Ribacke, M., Szecsenyi, J., and Grol, R.P.T.M.

Abstract

Item does not contain fulltext

Published
1998

22. The costs and benefits of asking patients for their opinions about general practice.

Author

Hearnshaw, Hilary, Baker, Richard, Cooper, Alison, Eccles, Martin, Soper, Jean, Hearnshaw, H, Baker, R, Cooper, A, Eccles, M, and Soper, J

Abstract

Background: Patient views are important in the evaluation of the quality of health care. The use of surveys needs to be evaluated to determine their cost-effectiveness and benefits.Objectives: To determine the costs of conducting patient opinion surveys in general practice and to find out how effective patient surveys are in stimulating changes which are beneficial for patient care.Method: Postal questionnaire to all 102 medical audit advisory groups (MAAGs) and 98 family health services authorities (FHSAs) in England and Wales, followed by postal questionnaire to 302 general practices reported to have conducted surveys, sampled by the type or questionnaire used. Numbers of MAAGs and FHSAs reporting surveys in general practice; types of questionnaire used; estimated costs; changes made; and benefits identified were measured.Results: Eighty-five (83%) MAAGs and 75 (77%) FHSAs responded. One hundred and fifty-four (96%) of MAAGs or FHSAs reported survey activity. Types of questionnaire used were 1) designed by the practice, 2) designed by the MAAG or FHSA, possibly in collaboration with a practice, or 3) standard 'off-the-shelf'. One hundred and thirty-three (44%) practices responded. Total costs to a practice of conducting a survey ranged from nothing to over 2200 Pounds. Questionnaires designed by the practice are likely to be more costly than other designs. Some practices had surveys provided free of charge by MAAG or FHSA. Sixty-one per cent of practices said changes had been implemented and a further 22% of practices said changes were planned. The most common change was to appointment systems. Benefits were identified for patients, staff, the practice, the MAAG or FHSA and the NHS. Surveys also brought benefits in relationships and understanding. Only 8.2% of practices felt the costs of surveys outweighed the benefits.Conclusions: Many practices are surveying patients' opinions. Surveys can be costly but MAAGs and FHSAs can provide expertise and resources. Surveys using any of the types of questionnaire are likely to lead to changes and identifiable benefits. Benefits of surveys are perceived by the majority of practices to outweigh the costs. [ABSTRACT FROM AUTHOR]

Published
1996
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23. Measuring patients' attitudes to care across the primary/secondary interface: the development of the patient career diary.

Author

Baker, R, Preston, C, Cheater, F, and Hearnshaw, H

Abstract

A growing number of new ways of organising services across the primary/secondary interface are being introduced and evaluated. The principal motive for such reorganisation is to improve the efficiency of health care. However, unless the impact of the new services on patients is investigated and taken into account, it is possible that patients' reactions could be negative, a factor that could lead to unexpected consequences in the use and costs of services.

Published
1999

24. Left in limbo: patients' views on care across the primary/secondary interface.

Author

Preston, C, Cheater, F, Baker, R, and Hearnshaw, H

Abstract

To discover the views of patients about their experiences across the interface between primary and secondary health care, including referral from general practitioners, outpatient and inpatient care, discharge, and aftercare.

Published
1999

25. Introducing a quality improvement programme to primary healthcare teams.

Author

Hearnshaw, H, Reddish, S, Carlyle, D, Baker, R, and Robertson, N

Abstract

To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect.

Published
1998

27. Assessing the work of medical audit advisory groups in promoting audit in general practice.

Author

Baker, R, Hearnshaw, H, Cooper, A, Cheater, F, and Robertson, N

Abstract

Objectives--To determine the role of medical audit advisory groups in audit activities in general practice. Design--Postal questionnaire survey. Subjects--All 104 advisory groups in England and Wales in 1994. Main measures--Monitoring audit: the methods used to classify audits, the methods used by the advisory group to collect data on audits from general practices, the proportion of practices undertaking audit. Directing and coordinating audits: topics and number of practices participating in multipractice audits. Results--The response rate was 86-5%. In 1993-4, 54% of the advisory groups used the Oxfordshire or Kirklees methods for classifying audits, or modifications of them. 99% of the advisory groups collected data on audit activities at least once between 1991-2 and 1993-4. Visits, questionnaires, and other methods were used to collect information from all or samples of practices in each of the advisory group's areas. Some advisory groups used different methods in different years. In 1991-2, 57% of all practices participated in some audit, in 1992-3, 78%, and in 1993-4, 86%. 428 multipractice audits were identified. The most popular topic was diabetes. Conclusions--Advisory groups have been active in monitoring audit in general practice. However, the methods used to classify and collect information about audits in general practices varied widely. The number of practices undertaking audit increased between 1991-2 and 1993 1. The large number of multipractice audits supports the view that the advisory groups have directed and coordinated audit activities. This example of a national audit programme for general practice may be helpful in other countries in which the introduction of quality assurance is being considered.

Published
1995

29. The release of luteinizing hormone by oestradiol-17 and a synthetic gonadotrophin-releasing factor in ewes affected with clover disease

Author

Goding, Jock K. Findlay, Joan M. Buckmaster, Chamley Wa, Cumming Ia, and Hearnshaw H

Subjects
Plant Poisoning, Embryology, medicine.medical_specialty, Sheep, Estradiol, Obstetrics and Gynecology, Sheep Diseases, Cell Biology, Biology, Luteinizing Hormone, Gonadotrophin releasing factor, Endocrinology, Reproductive Medicine, Internal medicine, Injections, Intravenous, medicine, Prostaglandins, Animals, Female, Luteinizing hormone, Peptides, Pituitary Hormone-Releasing Hormones
Published
1973

30. Endocrinological and histopathological aspects of the infertility in the ewe caused by oetrogenic clover

Author

Goding, Cumming Ia, Hearnshaw H, Nairn M, and Brown Jm

Subjects
Infertility, Embryology, medicine.medical_specialty, Uterus, Sheep Diseases, Biology, Endocrinology, Internal medicine, Adrenal Glands, medicine, Endocrine system, Animals, Progesterone, Plant Poisoning, Sheep, Estradiol, Adrenal cortex, Ovary, Obstetrics and Gynecology, Uterine horns, Estrogens, Cell Biology, Luteinizing Hormone, medicine.disease, Squamous metaplasia, medicine.anatomical_structure, Reproductive Medicine, Pituitary Gland, Female, sense organs, Luteinizing hormone, Infertility, Female, Hormone
Abstract

The possible causes of infertility induced by potent estrogenic clover were studied in 50 permanently infertile ewes. Progesterone concentrations were normal throughout the cycle in 7 of 12 animals studied; the remainder showed either high or low concentrations. Histologic examination of these animals did not reveal any consistent changes in the H/E sections of the pituitary glands or evidence of hyperplastic changes in the adrenal cortex. In the cervix cycstic changes were much more severe than in the uterine horns and squamous metaplasia was observed in 1 animal. Luteinizing hormone (LH) concentrations were assessed in 6 animals after a single injection of 40 mcg estradiol-17beta (E2) 1 week after the animals were spayed. 5 of the ewes exhibited the rapid release of LH in response to E2 that is found in the normal spayed ewe. The results show that the infertility caused by clover is related to morphological changes that occur primarily in the cervix. It is also possible that estrogenic clover creates imb alances in the luteolytic system.

Published
1972

31. Older patients' involvement in their health care: Can paper-based tools help? A feasibility study in 11 European countries

Author

Klingenberg, A., Hearnshaw, H., Wensing, M., Pedro Ferreira, Raposo, V., and Szecsenyi, J.

Subjects
Paper-based tools, Doctor–patient communication, Older patients, General practice, Patient involvement
Abstract

Three paper-based tools to enhance older patients’ involvement in general practice care have been used and evaluated by 63 general practitioners (GPs) and 351 patients in 10 European countries and Israel within the IMPROVE project. In all countries the tested tools were helpful for some patients, by encouraging them to ask questions, address important issues and offer their own opinions. In none of the participating countries were the tools suitable to be used universally with all older patients, and sometimes they even hindered patient involvement. In everyday practice, tools may be used from time to time, in order to remind and motivate older patients and their GPs to pay more attention to the patient’s view. GPs should tailor the choice and the use of any instrument to the individual patient, and it should be the patient’s choice whether to use a specific tool or not.

32. Stakeholder Perspectives on the Development of a Virtual Clinic for Diabetes Care: Qualitative Study

Author

Armstrong, Natalie, Hearnshaw, Hilary, Powell, John, and Dale, Jeremy

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

Background The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based “virtual clinic,” which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users. Objective The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management. Methods Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized. Results Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described. Conclusions Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study.

Published
2007
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34. Consequences of growth retardation early in the life of cattle.

Author

Greenwood, P. L., Cafe, L. M., Hearnshaw, H., and Hennessy, D. W.

Subjects
*DWARFISM, *CATTLE growth, *BULLS, *ANIMAL nutrition, *NUTRITION
Abstract

Background -- The beef industry in Australia is subject to variable pasture availability and quality. This results in numerous growth path possibilities that may influence growth potential and body and carcass composition of cattle and eating quality of beef. Studies of cattle within pasture-based nutritional systems have failed to demonstrate substantial long-term differences in body or carcass characteristics due to prenatal nutrition and growth or nutrition and growth from birth to weaning. However, severe nutritional restriction from birth to weaning followed by concentrate (high energy) feeding from weaning resulted in increased fatness at the same live and carcass weights compared to cattle well-nourished to weaning. Furthermore, the extent to which growth early in life interacts with genotype to influence long-term outcomes for growth, carcass and beef quality characteristics of cattle has not been investigated. Objective -- To determine the extent to which prenatal and pre-weaning growth influence subsequent growth, composition and meat eating quality of cattle sired by bulls with high muscle (Piedmontese breed) or high intramuscular fat (Wagyu breed) growth capacity. Design -- Piedmontese x Hereford (n = 120) and Wagyu x Hereford (n = 120) calves of low (28.6 kg, n = 120) or high (38.8 kg, n = 120) birth weight were nourished to grow slowly (554 g/d, n = 119) or rapidly (875 g/d, n = 121) to weaning at 7 months of age (total n = 240). They were grown from weaning to feedlot entry at 26 months of age on improved, temperate pasture, then lot-fed a grain-based diet until conclusion of the study at 30 months of age. Outcomes -- Low birth weight calves grew more slowly to weaning and in the feedlot, were 56 kg smaller on average at conclusion of the study, and had similar composition and eating quality characteristics compared to those of high birth weight. Cattle grown slowly to weaning weighed 70 kg less at weaning, grew more rapidly post-weaning but remained 40 kg lighter at conclusion of the study, and were leaner and had similar meat eating quality at 30 months of age compared to those grown rapidly to weaning. Genotype x early-life nutrition interactions were not evident. Conclusions -- Fetal growth retardation resulted in slower subsequent growth and reduced size of cattle, but had little effect on composition and meat eating quality at 30 months of age. In cattle grown slowly to weaning, compensation in weight was incomplete and cattle were leaner with similar meat eating quality at 30 months of age. These findings on consequences of low birth weight for body or carcass composition are consistent with previous research in cattle,1 but in contrast to findings in sheep grown to 20 kg4 or 35 kg5 live weight in which increased fatness was evident following severe foetal growth retardation that resulted in low birth weight. However, our findings are consistent with previous studies in sheep that showed no adverse effects on eating quality due to restricted nutrition during pregnancy, and with previous research in cattle in which nutrition and growth early in life did not adversely affect beef eating quality characteristics. [ABSTRACT FROM AUTHOR]

Published
2005

35. 40(th) EASD Annual Meeting of the European Association for the Study of Diabetes : Munich, Germany, 5-9 September 2004

Author

S. Artigas, A V Dreval, Mark I. McCarthy, C Watson, Peter H. Bennett, M Quint, Y Ikeda, E Alpert, F Schiele, H Sekihara, Erik Gylfe, P Lowe, J Kuhlmann, Alain Golay, V Longo, Shahidul Alam Khan Akm., L G Mantovani, M Zawodniak-Szalapska, G Winkler, T Harrity, L Virág, U Johne, Kuo S-W., Linda C Tapsell, J Rodriguez, Michel Komajda, K Kankova, Carole A. Cull, M Sporna, E Estilles, U Ribel, M C Spruce, E Buzzigoli, T Prazak, J K McLaughlin, M K Lingohr, M Lim, F Calara, A Siebenhofer, G Meregalli, Roberto Anichini, A D Baron, R Kurashvili, P C Butler, G I Fantus, T. E. De Gooyer, Park Y-M., R. Walther, S Heinrich, Agnieszka Zawiejska, S Mukherjee, Nikolaos Papanas, G Wong, Ian D. Caterson, David M. Maahs, Shuichi Kaneko, Alexandra E. Butler, Francisco Javier Ampudia-Blasco, O N Kong, Attali J-R., C A Hedman, K Oshinyemi, Nicolle Müller, I C Cranston, N Okumus, M V Vlaiculescu, Balasubramanian Ravikumar, W W Cheatham, K Mukasa, K B Biswas, Annunziata Lapolla, Phil McEwan, G Mader, Gilles Chassot, Dragi Anevski, Werner A. Scherbaum, M Donath, C Hesselmann, R A Gandhi, David E. Moller, Ezio Bonifacio, C Garcia, V Ifandi, P Hornnes, Nieuwenhoven Fav., C Puech, S Pérez-Del-Pulgar, Kim S-R., G Hines, C Rubio Terrés, Michael Gaster, N. Hosszufalusi, A Scholze, Andrew A. Young, Stavros Liatis, F Hariri, S Tan, Paul Valensi, Allan E. Karlsen, J Kim, E. Moberg, J Kaiser, L Berman, G Nelson, A Altkrüger, P Kothare, D B Cook, S Doran, G. van Dijk, Shahnaz Shahinfar, Kim C-S., P Stahl, M Manousaki, S Sigrist, S K Lim, M. P. Stern, A Guberti, C Rezzani, J McKenney, Karl Thomaseth, Sofia Carlsson, M Julia, R Brillante, I Rubesova, T Darkow, E Matsumoto, Wendy M. Macfarlane, M Di Martino, G Bardini, Rossella Menghini, D Duhot, E Farcasiu, Annalisa Natalicchio, I Lindner, J Buvat, Christian L. Brand, Harry Dorchy, Iwona Pietrzak, Z T Luo, P Home, M Ekelund, Jesper Gromada, Kristine Færch, F Piarulli, H Kim, R Mentel, Zsuzsanna K. Zsengellér, Dullaart Rpf., Anton Luger, Thomas A. Pearson, V Manicardi, P Rösen, Feng Y-M., R Morganti, Lars Hansen, Demuth H-U., Haruo Kasai, A Shostak, Rudi Steffensen, G Taylor, Markolf Hanefeld, C Santini, E Hamaguchi, Roberto Miccoli, F Storms, M Cooper, Y Lee, Allison E. Aiello, P Smith, T Suehiro, K Treece, M Waluś, Timothy A Welborn, Simone Baltrusch, E Kontela, S Chai, J Crean, H Yokoyama, Johan G. Eriksson, Rafael Hernández Hernández, J Rodríguez-Saldaña, M P Tornero, G Formoso, D. Lovell, E Bingham, A Mylonakis, M Manteghetti, D Fedele, Antonio Martín-Duce, Ralph A. DeFronzo, D Salcedo, Kurt Højlund, Antonio Petrone, Sheu Whh., C Gutierrez, Flavia Pricci, S Kurita, Z G Abbas, M M Benedetti, Philippe A. Halban, Daniel J. Cox, O Ljungkvist, Justine Davies, J Palsgaard, Lars Sjöström, E Bosi, L Janin-Manificat, W. F. Kelly, M. Fernandez, E Colak, O V Mulyarchik, B Kronshage, F Lang, M Erfurth, Takashi Kadowaki, N Jendrike, U Walter, J Wishart, Y. Neye, D Kim, N Furuhashi, M Barsotti, D Florow, L Ke, L Borgquist, N C Jackson, Ffolliott M. Fisher, V Baskar, K Yoshioka, Bryan A. Wolf, G Chabrier, R Skoumal, Livio Luzi, H Kose, I Pharisien, B. Klein, H Winiarska, M C Johnson, L Griffiths, Nonna Kravchun, C Combe, Baptist Gallwitz, J Zdychova, L Skorda, Jorma Ilonen, W Gao, I N Steen, A Terrinoni, P D Ambery, W Kern, C M Kusminski, Cho M-H., Paolo Pozzilli, Louise G. Grunnet, E Schönle, David R Matthews, Robert W. Taylor, Y Cohen, Kim H-S., M P Eccles, N B Tutuncu, D McDowell, Richard M. Bergenstal, K Takamatsu, T Steiner, Jaan Palgi, Valdemar Grill, N Niculescu, G Federici, S Lehto, P. M. McKeigue, M Barone, Michael E. Trautmann, S Smirnov, J Mannion, M Eto, C Rousseau, M Conti, C S Ernest, Antonio Ceriello, D H Schweitzer, Jung E-D., Andreas Festa, Avijit Lahiri, A Shepelkevich, A Murro, A Kollmann, Jonathan R.S. Arch, R Landgraf, Son H-Y., I Engelsberger, E Agardh, S Rodríguez-Mulero, P J Kraml, K Lee, D. F. Du Toit, E Kim, G Fadini, Williams Ajk., Philip Home, M B Antcieferov, C Perlemoine, D Perrea, Song X-L., D Ruggieri, Krister Bokvist, Heidi Sørensen, Bilbao, G Yoshino, J P Taylor, Shen H-M., S M Furier, R Urquhart, J Wohlgelernter, Jianping Weng, T. Baba, Q Hong, C Silva, Castaigne J-P., M Felaco, X X Zhang, M Jaroň, Milla Rosengård-Bärlund, J G Papp, Toshio Miyata, Lervang H-H., Park M-K., I Kinalska, A Long, Oomen Phn., N Kogawa, Ippolita Patrizia Patera, S. Karadeniz, Dinesh Selvarajah, D S Chung, A Wensaas, Richard Imrich, M Recasens, J Ruxer, O Buchea, E Wilpart, S P Stepanenko, Le Ttd., H Ohgawara, Mariaconsuelo Valentini, A Mondok, M Peltonen, Marianne O. Larsen, K Chatzianagnostou, Agneta Ståhle, A L Ferrari, L Bordier, F Maingrette, A Matsuda, G Vukomanovic, Jakob D. Wikstrom, T Yamakita, E Gorostiaga, J Jin, B Gopalan, Heinz Drexel, S Hewitt, Rury R. Holman, C Dieterle, T L Ruchti, N Asatiani, M Sidira, A Iezzi, A J Sommerfield, D Châtenet, M L Olsen, R Bergemann, C Koehler, T L Kuraeva, B Balas, Christian Berne, E Santos-Mazo, G Smith, A Siejka, R Kožnarová, A Mattina, S Sheikh, A Adomeit, M Rasmussen, J. Fagerudd, N Busciantella Ricci, Nuria Vilarrasa, E Hammar, T L Thoms, L Aydın, Ron G. Rosenfeld, A Nikolajuk, R Gos, C L Morgan, H L Yu, D Dheelchand, S Ramrath, N Boudriga, Jerome I. Rotter, C Jahannault, W M Weston, Folke Lindgärde, M Hertlova, D Knight, A Monroy-Mayorga, E Pardini, A Chamson-Reig, B Franke, Janie McCluskey, Joseph Bryan, C Nikolopoulou, Christie M. Ballantyne, Fausto Santeusanio, L Pegoraro, M Lee, A Klimenko, S Jaiveer, K. Pettersson-Fernholm, Michael A. 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Dell'Antonio, G, Maestroni, A, Ruggieri, D, Luzi, L, Piemonti, L, Zerbini, G, Anafaroglu, I, Tutuncu, N, Sultana, M, Siddiqua, N, Iwasaki, T, Nakajima, A, Yoneda, M, Mukasa, K, Tanaka, S, and Sekihara, H

Subjects
0303 health sciences, medicine.medical_specialty, business.industry, EASD, Endocrinology, Diabetes and Metabolism, Human physiology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Family medicine, Internal Medicine, Medicine, business, 030217 neurology & neurosurgery, 030304 developmental biology
Published
2004

36. Assessment of the benefits of user involvement in health research from the Warwick Diabetes Care Research User Group: a qualitative case study.

Author

Lindenmeyer A, Hearnshaw H, Sturt J, Ormerod R, and Aitchison G

Subjects
Female, Group Processes, Humans, Male, Qualitative Research, Advisory Committees organization & administration, Diabetes Mellitus therapy, Health Services Research organization & administration, Organizational Case Studies, Patient Participation methods
Abstract

Objective: To assess the benefits of involving health-care users in diabetes research., Design and Participants: For this qualitative case study, semi-structured interviews were conducted with researchers who had worked extensively with the group. During regular meetings of the Research User Group, members discussed their views of the group's effectiveness as part of the meeting's agenda. Interviews and discussions were transcribed, coded using N-Vivo software and analysed using constant comparative methods., Results: Involvement of users in research was generally seen as contributing to effective and meaningful research. However, the group should not be considered to be representative of the patient population or participants of future trials. An important contributor to the group's success was its longstanding nature, enabling users to gain more insight into research and form constructive working relationships with researchers. The user-led nature of the group asserted itself, especially, in the language used during group meetings. A partial shift of power from researchers to users was generally acknowledged. Users' main contribution was their practical expertise in living with diabetes, but their involvement also helped researchers to remain connected to the 'real world' in which research would be applied. While the group's work fulfilled established principles of consumer involvement in research, important contributions relying on personal interaction between users and researchers were hard to evaluate by process measures alone., Conclusions: We demonstrated the feasibility, acceptability and effectiveness of this longstanding, experienced, lay-led research advisory group. Its impact on research stems from the continuing interaction between researchers and users, and the general ethos of learning from each other in an on-going process. Both process measures and qualitative interviews with stakeholders are needed to evaluate the contributions of service users to health research.

Published
2007
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37. Telecare motivational interviewing for diabetes patient education and support: a randomised controlled trial based in primary care comparing nurse and peer supporter delivery.

Author

Dale J, Caramlau I, Docherty A, Sturt J, and Hearnshaw H

Abstract

Background: There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services., Methods/design: In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. DISCUSSION AND IMPLICATIONS OF THE RESEARCH: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications., Trial Registration: Current Controlled Trials, ISRCTN63151946.

Published
2007
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38. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes.

Author

Shaw B, Cheater F, Baker R, Gillies C, Hearnshaw H, Flottorp S, and Robertson N

Subjects
Humans, Randomized Controlled Trials as Topic, Outcome and Process Assessment, Health Care standards, Professional Practice standards
Abstract

Background: Strategies to implement change in health professional performance have variable impact. A potential explanation is that the barriers to implementation are different in different settings and at different times. Change may be more likely if the strategies were specifically chosen to address the identified barriers., Objectives: To assess the effectiveness of strategies tailored to address specific, identified barriers to change in professional performance., Search Strategy: We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register and pending files until end of December 2002. English language articles only were included., Selection Criteria: Randomised controlled trials (RCTs) that reported objectively measured professional practice or health care outcomes in which at least one group received an intervention designed (or tailored) to address prospectively identified barriers to change., Data Collection and Analysis: Two reviewers independently extracted data and assessed quality. We also contacted study authors to obtain any missing information. Quantitative and qualitative analyses were undertaken., Main Results: We included 15 studies. For Comparison 1 (an intervention tailored to address identified barriers to change compared to no intervention or an intervention(s) not tailored to the barriers), there was no consistency in the results and the effect sizes varied both across and within studies.A meta-regression of a subset of the included studies, using a classical approach estimated a combined OR of 2.18 (95% CI: 1.09, 4.34), p = 0.026 in favour of tailored interventions. However, when a Bayesian approach was taken, meta-regression gave a combined OR of 2.27 (95% Credible Interval: 0.92, 4.75), which was not statistically significant., Authors' Conclusions: Interventions tailored to prospectively identify barriers may improve care and patient outcomes. However, from the studies included in this review, we were unable to determine whether the barriers were valid, which were the most important barriers, whether all barriers were identified and if they had been addressed by the intervention chosen. Based on the evidence presented in this review, the effectiveness of tailored interventions remains uncertain and more rigorous trials (including process evaluations) are needed. Further research needs to address explicitly the questions of identifying and addressing barriers.

Published
2005
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39. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus.

Author

Vermeire E, Wens J, Van Royen P, Biot Y, Hearnshaw H, and Lindenmeyer A

Subjects
Diabetes Mellitus, Type 2 psychology, Health Behavior, Humans, Patient Education as Topic, Randomized Controlled Trials as Topic, Diabetes Mellitus, Type 2 therapy, Patient Compliance psychology
Abstract

Background: Research suggests adherence to treatment recommendations is low. In type 2 diabetes, which is a chronic condition slowly leading to serious vascular, nephrologic, neurologic and ophthalmological complications, it can be assumed that enhancing adherence to treatment recommendations may lead to a reduction of complications. Treatment regimens in type 2 diabetes are complicated, encompassing life-style adaptations and medication intake., Objectives: To assess the effects of interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus., Search Strategy: Studies were obtained from searches of multiple electronic bibliographic databases supplemented with hand searches of references. Date of last search: November 2002., Selection Criteria: Randomised controlled and controlled clinical trials, before-after studies and epidemiological studies, assessing changes in adherence to treatment recommendations, as defined in the objectives section, were included., Data Collection and Analysis: Two teams of reviewers independently assessed the trials identified for inclusion. Three teams of two reviewers assessed trial quality and extracted data. The analysis for the narrative part was performed by one reviewer (EV), the meta-analysis by two reviewers (EV, JW)., Main Results: Twentyone studies assessing interventions aiming at improving adherence to treatment recommendations, not to diet or exercise recommendations, in people living with type 2 diabetes in primary care, outpatient settings, community and hospital settings, were included. Outcomes evaluated in these studies were heterogeneous, there was a variety of adherence measurement instruments. Nurse led interventions, home aids, diabetes education, pharmacy led interventions, adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c. No data on mortality and morbidity, nor on quality of life could be found., Authors' Conclusions: Current efforts to improve or to facilitate adherence of people with type 2 diabetes to treatment recommendations do not show significant effects nor harms. The question whether any intervention enhances adherence to treatment recommendations in type 2 diabetes effectively, thus still remains unanswered.

Published
2005
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41. Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners.

Author

Khunti K, Hearnshaw H, Baker R, and Grimshaw G

Subjects
Aged, Attitude of Health Personnel, Evidence-Based Medicine trends, Family Practice trends, Female, Health Care Surveys, Heart Failure mortality, Humans, Male, Middle Aged, Physicians, Family, Practice Guidelines as Topic, Practice Patterns, Physicians', Primary Health Care trends, Quality of Health Care, Severity of Illness Index, Surveys and Questionnaires, Survival Analysis, Treatment Outcome, United Kingdom, Evidence-Based Medicine standards, Family Practice standards, Guideline Adherence, Heart Failure diagnosis, Heart Failure therapy, Outcome Assessment, Health Care, Primary Health Care standards
Abstract

Background: Chronic heart failure is a common clinical condition with high morbidity and mortality. Despite the evidence that appropriate treatment with angiotensin-converting enzyme inhibitors can improve morbidity, primary care studies show that patients with heart failure are incorrectly diagnosed and inadequately treated., Aim: To explore general practitioners' accounts of their management of patients with heart failure and identify the perceived obstacles to diagnosis and management., Methods: We conducted this qualitative study using semi-structured interviews in 18 general practices. The practices were stratified on the basis of size, location, and the level of practice development. The interviews were based on a schedule of open questions based on the literature on diagnosis and management of patients with heart failure. Transcriptions of the audiotaped interviews were independently analysed by two researchers and analysis was based on open coding using a constant comparative approach. Categories were reduced to major themes., Results: General practitioners suspect heart failure when patients present with breathlessness or ankle oedema. Many general practitioners reported that they would diagnose heart failure after respiratory examination and a positive finding of basal crepitations. Many general practitioners arrange a chest X-ray to establish the diagnosis and some arrange an electrocardiogram. A few general practitioners mentioned that they diagnosed heart failure with a trial of diuretics. Obstacles to diagnosis were mentioned by most general practitioners and included lack of facilities for appropriate investigations (especially echocardiography) and lack of time and expertise. Obstacles to management included lack of time, high cost of drugs, difficulty with diagnosis, selection bias towards younger patients and not having the confidence to initiate angiotensin-converting enzyme inhibitors. Many general practitioners were unaware of the impact angiotensin-converting enzyme inhibitors can have on morbidity and mortality., Conclusions: Although symptoms of heart failure are not sufficiently specific for diagnosing patients with heart failure, many general practitioners in European countries treat people with suspected heart failure on the basis of symptoms and signs alone. This study has identified many obstacles to the diagnosis and management of heart failure that may explain why patients are inadequately managed in primary care. Specific implementation strategies need to be tailored to overcome these obstacles., (Copyright 2002 European Society of Cardiology)

Published
2002
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42. Patient satisfaction with availability of general practice: an international comparison.

Author

Wensing M, Vedsted P, Kersnik J, Peersman W, Klingenberg A, Hearnshaw H, Hjortdahl P, Paulus D, Künzi B, Mendive J, and Grol R

Subjects
Adult, Europe, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Family Practice, Health Services Accessibility statistics & numerical data, Patient Satisfaction
Abstract

Objective: To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice., Design: Written surveys completed by patients., Setting: General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia and Spain., Study Participants: 15996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%)., Main Measures: The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice., Results: Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries., Conclusion: Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved.

Published
2002
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43. A study of the methods used to select review criteria for clinical audit.

Author

Hearnshaw H, Harker R, Cheater F, Baker R, and Grimshaw G

Subjects
Delphi Technique, England, Guidelines as Topic, Health Services Research, Hospitals, Public standards, Humans, Interviews as Topic, Medical Audit methods, Quality Assurance, Health Care, Reproducibility of Results, Surveys and Questionnaires, Total Quality Management, Wales, Medical Audit standards, Quality Indicators, Health Care, State Medicine standards
Published
2002
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44. Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice.

Author

Baker R, Reddish S, Robertson N, Hearnshaw H, and Jones B

Subjects
Family Practice standards, Humans, Psychiatric Status Rating Scales, Depressive Disorder therapy, Family Practice methods, Guideline Adherence standards, Practice Guidelines as Topic
Abstract

Background: Various methods are available for implementing change in the clinical behaviour of general practitioners (GPs). Although passive dissemination of information is generally ineffective, other methods can be variably effective. Few studies have investigated the impact of tailored methods., Aim: To determine whether methods tailored to overcome obstacles to change using psychological theories are more effective than dissemination alone in the implementation of guidelines for depression among GPs., Design of Study: Randomised controlled trial., Setting: Sixty general practices in England; 30 GPs in the control group, 34 in the intervention group., Method: Practitioners identified patients presenting with depression before and after the implementation of guidelines (control group n = 192 in the first data collection, n = 181 in the second; intervention group n = 210 in the first data collection and n = 197 in the second). The main outcome measures were: record of adherence to guideline recommendations in clinical records; proportion of patients with Beck Depression Inventory (BDI) score less than 11 at 16 weeks after diagnosis., Results: In comparison with the control group, in the group of GPs receiving tailored implementation, there were increases in the proportions of patients assessed for suicide risk. In the intervention group, the proportion of patients with BDI scores of less than 11 at 16 weeks increased., Conclusion: Obstacles to implementation can be identified and strategies tailored to address them. The findings indicate a new approach for research to understand and develop methods of implementation.

Published
2001

45. Patients in Europe evaluate general practice care: an international comparison.

Author

Grol R, Wensing M, Mainz J, Jung HP, Ferreira P, Hearnshaw H, Hjortdahl P, Olesen F, Reis S, Ribacke M, and Szecsenyi J

Subjects
Culture, Europe, Female, Humans, International Cooperation, Male, Middle Aged, Practice Guidelines as Topic standards, Surveys and Questionnaires, Delivery of Health Care standards, Family Practice standards, Patient Satisfaction
Abstract

Background: Patients' evaluations can be used to improve health care and compare general practice in different health systems., Aim: To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision., Method: An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP., Results: The patient sample included 17,391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed care as good or excellent; in particular, keeping records confidential, GP listening to patients, time during consultations, and quick services in case of urgent problems were evaluated positively. Patients were relatively negative about organisational aspects of care. The evaluations in different countries were largely similar, with some interesting differences; for instance, service and organisational aspects were evaluated more positively in fee-for-service health systems., Conclusions: Patients in Europe are positive about general practice but improvements in practice management in some countries are requested. More research is needed to study the complex field of differences in expectations and evaluations between countries with different health systems.

Published
2000

46. A survey of audit activity in general practice.

Author

Hearnshaw H, Baker R, and Cooper A

Subjects
Attitude of Health Personnel, Surveys and Questionnaires, United Kingdom, Family Practice standards, Medical Audit
Abstract

Background: Since 1991, all general practices have been encouraged to undertake clinical audit. Audit groups report that participation is high, and some local surveys have been undertaken, but no detailed national survey has been reported., Aim: To determine audit activities in general practices and the perceptions of general practitioners (GPs) regarding the future of clinical audit in primary care., Method: A questionnaire on audit activities was sent to 707 practices from 18 medical audit advisory group areas. The audit groups had been ranked by annual funding from 1992 to 1995. Six groups were selected at random from the top, middle, and lowest thirds of this rank order., Results: A total of 428 (60.5%) usable responses were received. Overall, 346 (85%) responders reported 125.7 audits from the previous year with a median of three audits per practice. There was no correlation between the number of audits reported and the funding per GP for the medical audit advisory group. Of 997 audits described in detail, changes were reported as 'not needed' in 220 (22%), 'not made' in 142 (14%), 'made' in 439 (44%), and 'made and remeasured' in 196 (20%). Thus, 635 (64%) audits were reported to have led to changes. Some 853 (81%) of the topics identified were on clinical care. Responders made 242 (42%) positive comments on the future of clinical audit in primary care, and 152 (26%) negative views were recorded., Conclusion: The level of audit activity in general practice is reasonably high, and most of the audits result in change. The number of audits per practice seems to be independent of the level of funding that the medical audit advisory group has received. Although there is room for improvement in the levels of effective audit activity in general practice, continued support by the professionally led audit groups could enable all practices to undertake effective audit that leads to improvement in patient care.

Published
1998

47. Proceedings: response of spayed ewes to administration of gonadotrophin releasing hormone (Gn-GH).

Author

Hearnshaw H, Restall BJ, and Starr BG

Subjects
Animals, Female, Gonadotropin-Releasing Hormone administration & dosage, Injections, Subcutaneous veterinary, Luteinizing Hormone blood, Ovulation, Pituitary Gland metabolism, Time Factors, Castration, Gonadotropin-Releasing Hormone pharmacology, Luteinizing Hormone metabolism, Pituitary Gland drug effects, Sheep physiology
Published
1975
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