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3 results on '"Penfold, Christopher M."'

1. Patient copayments in primary medical care

Author

Penfold, Christopher M.

Subjects
617.60068
Abstract

This research was carried out to assess the feasibility of studying the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care. Quantitative methods were used to investigate the impact of primary dental care copayments on patients and to compare predictors of primary medical and dental care uptake. Qualitative methods were used to investigate attitudes towards copayments for NHS primary health services and their extension to include primary medical consultations. Regression models, chi-square analyses and ANOVA were applied to the England and Wales sub-sample of nationally representative self-report data from the 1998 Adult Dental Health Survey (ADHS) (n=3628) to investigate the impact of copayments on primary dental care uptake. Regression models and chi-square analyses were applied to the England and Wales sub-sample of nationally representative self-report data from the 1997/98 British Household Panel Survey (BHPS) (n=8526) and the 1998 ADHS (n=3641) to compare predictors of primary medical and dental consultations. Semi- structured interviews were undertaken in Bristol and Somerset with purposively sampled frequent and infrequent primary medical care users (n=19). Predictors of primary medical and dental care utilisation differed across predisposing, enabling and illness level factors. Private and NHS dental copayments were perceived to be expensive and this perception was associated with lower preventive-led dental consultation rates, but not with treatment-led consultation rates. Copayments for services affected the nature of the patient-practitioner relationship. Findings were inconclusive regarding the effect of copayment exemption status on people's decisions to consult a dentist and on dental treatments received. It was not feasible to study the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care.

Published
2011

2. Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all-cause mortality:Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer

Author

Beynon, Rhona A., Lang, Samantha, Schimansky, Sarah, Penfold, Christopher M., Waylen, Andrea, Thomas, Steven J., Pawlita, Michael, Tim Waterboer, Martin, Richard M., May, Margaret, and Ness, Andy R.

Subjects
Aged, 80 and over, Male, Alcohol Drinking, alcohol, Smoking, Middle Aged, Prognosis, survival, smoking, Survival Rate, Head and Neck Neoplasms, Risk Factors, Humans, Female, head and neck cancer, Prospective Studies, ICEP, human papillomavirus, Cancer Epidemiology, Aged, Follow-Up Studies
Abstract

Tobacco smoking and alcohol consumption are well‐established risk factors for head and neck cancer. The prognostic role of smoking and alcohol intake at diagnosis have been less well studied. We analysed 1,393 people prospectively enrolled into the Head and Neck 5000 study (oral cavity cancer, n=403; oropharyngeal cancer, n=660; laryngeal cancer, n=330) and followed up for a median of 3.5 years. The primary outcome was all‐cause mortality. We used Cox proportional hazard models to derive minimally adjusted (age and gender) and fully adjusted (age, gender, ethnicity, stage, comorbidity, body mass index, HPV status, treatment, education, deprivation index, income, marital status, and either smoking or alcohol use) mortality hazard ratios (HR) for the effects of smoking status and alcohol intake at diagnosis. Models were stratified by cancer site, stage and HPV status. The fully‐adjusted HR for current versus never‐smokers was 1.7 overall (95% confidence interval [CI] 1.1, 2.6). In stratified analyses, associations of smoking with mortality were observed for oropharyngeal and laryngeal cancers (fully adjusted HRs for current smokers: 1.8 (95% CI=0.9, 3.40 and 2.3 (95% CI=0.8, 6.4)). We found no evidence that people who drank hazardous to harmful amounts of alcohol at diagnosis had a higher mortality risk compared to non‐drinkers (HR=1.2 (95% CI=0.9, 1.6)). There was no strong evidence that HPV status or tumour stage modified the association of smoking with survival. Smoking status at the time of a head and neck cancer diagnosis influenced all‐cause mortality in models adjusted for important prognostic factors., What's new? Smoking and alcohol use are risk factors for developing head‐and‐neck cancer (HNC) and are known to influence mortality in general. However, the prognostic role of smoking status and alcohol intake at time of diagnosis on HNC survival is less clear. In this study, the authors provide a comprehensive, prospective analysis of mortality risk in different tumour sites, adjusting for important prognostic factors such as stage, comorbidity, and HPV infection. These results may provide insight to inform and improve prediction of clinical outcomes.

Published
2018

3. Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all-cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer

Author

Beynon, Rhona A., primary, Lang, Samantha, additional, Schimansky, Sarah, additional, Penfold, Christopher M., additional, Waylen, Andrea, additional, Thomas, Steven J., additional, Pawlita, Michael, additional, Waterboer, Tim, additional, Martin, Richard M., additional, May, Margaret, additional, and Ness, Andy R., additional

Published
2018
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