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Regional Health Authorities (regional + health_authority)

Distribution by Scientific Domains

Medical Sciences	71%
Business, Economics, Finance and Accounting	28%

Selected Abstracts

Initial management of cerebrovascular disease by general practitioners

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000
R. G. J. Gibbs
Background: The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK. Methods: Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA. Results: There were twofold differences (P < 0·00005, ,2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 15·5 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs. Conclusion: The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising. © 2000 British Journal of Surgery Society Ltd [source]

Use of marketing to disseminate brief alcohol intervention to general practitioners: promoting health care interventions to health promoters

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2000
Catherine A. Lock BSc MA
Abstract Health research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. Thus, a dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. Social marketing techniques can be utilized to aid successful dissemination of research findings and to speed the process by which new information reaches practice. Principles of social marketing include manipulating the marketing mix of product, price, place and promotion. This paper describes the development of a marketing approach and the outcomes from a trial evaluating the effectiveness and cost-effectiveness of manipulating promotional strategies to disseminate actively a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). The promotional strategies consisted of postal marketing, telemarketing and personal marketing. The study took place in general practices across the Northern and Yorkshire Regional Health Authority. Of the 614 GPs eligible for the study, one per practice, 321 (52%) took the programme and of those available to use it for 3 months (315), 128 (41%) actively considered doing so, 73 (23%) actually went on to use it. Analysis of the specific impact of the three different promotional strategies revealed that while personal marketing was the most effective overall dissemination and implementation strategy, telemarketing was more cost-effective. The findings of our work show that using a marketing approach is promising for conveying research findings to GPs and in particular a focus on promotional strategies can facilitate high levels of uptake and consideration in this target group. [source]

Waiting for scheduled services in Canada: development of priority-setting scoring systems

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2003
T. W. Noseworthy MD MSc MPH FRCPC FACP FCCP FCCM CHE
Abstract Rationale, aims and objectives An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. Methods Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. Results Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. Conclusions While the WCWL project has not ,solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere. [source]

Negotiating the Network: The Contracting Experiences of Community Mental Health Agencies in New Zealand

FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 2 2001
Susan Newberry
Structural options for reforming New Zealand'spublicly funded health services included a hierarchy, a market model, or hybrid arrangements such as quasi-markets and networks. A survey of 28 community mental health agencies, contracting with the four regional health authorities, found that three structures emerged: a quasi-market, a coercive network and a beneficent network. Further reforms to the publicly funded health services created a single purchaser and preferred a network structure. Performance assessment of these reformed health services requires assessment of the whole network and not just individual components. The accounting profession, although closely involved in the public sector reforms, appears to have overlooked this task. [source]

Sampling for a longitudinal study of the careers of nurses qualifying from the English pre-registration Project 2000 diploma course

JOURNAL OF ADVANCED NURSING, Issue 4 2000
Louise Marsland PhD BSc RMN
Sampling for a longitudinal study of the careers of nurses qualifying from the English pre-registration Project 2000 diploma course This paper describes the processes involved in selecting a sample, from the eight English regional health authorities, of nurse qualifiers from all four branches of the Project 2000 pre-registration diploma course, for a longitudinal study of nurses' careers. A simple random sample was not feasible since accurate information about the population could not be obtained and the study design involved recruiting participants by personal visit. A multi-stage approach was therefore adopted in which ,college of nursing' was taken as the primary sampling unit. Sampling was further complicated by the fact that adult branch students could generally only be visited in larger groups than was ideal. Information obtained during pilot work about the accuracy of data about the population, course completion rates and the proportion of students who were likely to agree to participate was used to calculate required sampling fractions. The final sample was therefore a function of this information and the practicalities of recruiting nurses into the study. [source]

Waiting for scheduled services in Canada: development of priority-setting scoring systems

Health reform in Alberta: The introduction of health regions

CANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 2 2008
John Church
Consistent with the larger fiscal agenda, the government's intention was to address health-care system efficiency through larger integrated management and governance structures. In this article, the authors examine why Alberta decided to create regional health authorities for the management and delivery of a significant range of health services. In examining the interaction of ideas, interests and institutions, the authors conclude that the government was partially successful in aligning existing institutional and interest relationships with an emerging political consensus about cost and sustainability of the health-care system. Sommaire: En 1994, le gouvernement de l'Alberta a adopté la loi intitulée Regional Health Authorities Act (Loi sur les offices régionaux de santé) en vue d'abolir près de 200 commissions hospitalières et commissions de santé publique locales et de les remplacer par dix-sept offices régionaux de la santé. Conformément au programme fiscal plus large, l'intention du gouvernement était d'examiner l'efficience du système des soins de santé grâce à des structures intégrées de gestion et de gouvernance plus vastes. Dans le présent article, les auteurs examinent les raisons pour lesquelles l'Alberta a décidé de créer des offices régionaux de la santé pour la gestion et la prestation d'une gamme importante de services de santé. Après avoir étudié les interactions d'idées, d'intérêts et d'institutions, les auteurs ont conclu que le gouvernement avait partiellement réussi à aligner les relations institutionnelles et les relations d'intérêts existantes sur un consensus politique émergent au sujet des coûts et de la viabilité du système de soins de santé. [source]