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Objectives: The use of Out of Area (OoA) psychiatric placements for people with "Personality Disorder" (PD) is widespread in the UK. An innovative local intensive psychotherapeutic service, adapted to the transdiagnostic presentations of the most complex PD patients, likely to be placed out of the area, was devised in the English County of Devon. This paper reports the findings of a Freedom of Information (FOI) request to commissioners attempting to quantify PD OoA placements in England and the cost offset of the local therapeutic alternative to OoA placements in Devon., Design and Methods: Data from FOI requests was combined with publicly available sources to assess the scale of OoA placements for people with PD in England. OoA service use and cost data were used to examine the cost offset and effectiveness of the local alternative to OoA placements in Devon. The results found a lack of transparency and excessive use of OoA placements despite UK Government intentions. Data from the local therapeutic service demonstrated cost-effectiveness, reducing OoA placements and increasing the availability of psychotherapeutic services. This paper suggests the number of OoA placements can be reduced for people with severe and complex PD. The local therapeutic service provides a model for future rehabilitation pathways., (© 2024 The Author(s). Personality and Mental Health Published by John Wiley & Sons Ltd.)

Aims: To compare agreement level and identify reasons for disagreement between grading of mydriatic digital photographs in a diabetic retinopathy screening service and hospital eye service biomicroscopy grading., Methods: Structured examination findings leading to automatically calculated National Screening Committee grades recorded on an electronic medical record system in the hospital eye service at the first clinic visit after diabetic retinopathy screening service referral between April 2006 and November 2007 were retrospectively compared with the grade at the screening visit that prompted referral. In cases of disagreement, screening images were reviewed., Results: Data on 452 eyes (226 patients) were analysed. For retinopathy, hospital eye service slit-lamp biomicroscopy grades were: R0 (no diabetic retinopathy) in 63 eyes; R1 (background retinopathy) in 251 eyes; R2 (pre-proliferative) in 129 eyes and R3 (proliferative) in nine eyes. Diabetic retinopathy screening service grades were in agreement in 350 eyes (77.4%), showed a lower grade in 59 eyes and a higher grade in 43. Agreement was moderate (κ=0.60). The most common reason for disagreement was overgrading of R1 by clinicians. Hospital eye service biomicroscopy maculopathy grades were: M0 (no maculopathy) in 366 eyes and M1 (maculopathy) in 86 eyes. Diabetic retinopathy screening service grades were in agreement in 327 eyes (72.3%), showed a lower grading in five eyes and a higher grade in 120 eyes. Agreement was moderate (κ=0.41). The commonest cause for disagreement was clinicians failing to identify fine macular exudates., Conclusions: This study of routine clinical services demonstrates moderate agreement between non-medical grading of mydriatic digital retinal photography images and hospital slit-lamp biomicroscopy grading of patients referred with diabetic retinopathy. The majority of errors in grading were attributable to errors by hospital doctors, usually in the direction of under-grading which could be a potential source of clinical risk if treatment is delayed., (© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.)

Economic evaluation of health care interventions usually requires the collection of service use data to estimate the total cost of participants in an evaluation. There are a number of methods available to measure the quantity of services used but little is known about the relative accuracy of alternative methods. In a multicentre randomised controlled trial of interventions for the treatment of adults with recurrent episodes of deliberate self-harm (the POPMACT trial), health service data were collected by patient self-report after six and twelve months and also from GP records by independent investigators. Agreement for overall costs was relatively high. However, this hides substantial variation in agreement between the two sources of information for different services. The results suggest that GP records provide more accurate data on the use of general practice-based contacts than patient report, but less reliable information on contacts with other health services. Thus reliance on GP records for data on hospital services and other community health services based outside of general practice surgeries is not recommended. Future research should explore the level of agreement between patient report and other providing sector records, such as hospital records., (Copyright (c) 2006 John Wiley & Sons, Ltd.)