Ethnicity and primary care. A comparative study of doctor-patient relationship, perceived health, symptomatology, and use of general practitioner services by Asian and white patients, and the Bradford general practitioners' attitudes towards these patients.
AuthorAhmad, Waqar I-U.
SupervisorBaker, Mark R.
Kernohan, Elizabeth E.M.
General practitioners (GPs)
Bradford, West Yorkshire
The University of Bradford theses are licenced under a Creative Commons Licence.
InstitutionUniversity of Bradford
DepartmentPostgraduate School of Studies in Biomedical Sciences
MetadataShow full item record
AbstractBritain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.
Showing items related by title, author, creator and subject.
Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reportingWard, J.K.; McEachan, Rosemary; Lawton, R.; Armitage, Gerry R.; Watt, I.S.; Wright, J.; Yorkshire Quality Safety Research Group (2011)BACKGROUND: Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur. METHODS: To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis.To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient safety. A patient panel will provide steering to the research. DISCUSSION: The PMOS and PIRT aim to provide a reliable means of eliciting patient views about patient safety. Both interventions are likely to have relevance and practical utility for all NHS hospital trusts.
Towards patient-tailored perimetry: automated perimetry can be improved by seeding procedures with patient-specific structural informationDenniss, Jonathan; McKendrick, A.M.; Turpin, A. (2013-04)To explore the performance of patient-specific prior information, for example, from structural imaging, in improving perimetric procedures. Computer simulation was used to determine the error distribution and presentation count for Structure–Zippy Estimation by Sequential Testing (ZEST), a Bayesian procedure with prior distribution centered on a threshold prediction from structure. Structure-ZEST (SZEST) was trialled for single locations with combinations of true and predicted thresholds between 1 to 35 dB, and compared with a standard procedure with variability similar to Swedish Interactive Thresholding Algorithm (SITA) (Full-Threshold, FT). Clinical tests of glaucomatous visual fields (n = 163, median mean deviation −1.8 dB, 90% range +2.1 to −22.6 dB) were also compared between techniques. For single locations, SZEST typically outperformed FT when structural predictions were within ± 9 dB of true sensitivity, depending on response errors. In damaged locations, mean absolute error was 0.5 to 1.8 dB lower, SD of threshold estimates was 1.2 to 1.5 dB lower, and 2 to 4 (29%–41%) fewer presentations were made for SZEST. Gains were smaller across whole visual fields (SZEST, mean absolute error: 0.5 to 1.2 dB lower, threshold estimate SD: 0.3 to 0.8 dB lower, 1 [17%] fewer presentation). The 90% retest limits of SZEST were median 1 to 3 dB narrower and more consistent (interquartile range 2–8 dB narrower) across the dynamic range than those for FT. Seeding Bayesian perimetric procedures with structural measurements can reduce test variability of perimetry in glaucoma, despite imprecise structural predictions of threshold. Structural data can reduce the variability of current perimetric techniques. A strong structure–function relationship is not necessary, however, structure must predict function within ±9 dB for gains to be realized.
A home physiotherapy service for stroke patients in Malta: constraints and recommendations. The process of setting up a home physiotherapy service for hospitalised stroke patients within the public health system in Malta - new knowledge contributing to a strategy document.Hepworth, Deborah; Lungaro-Mifsud, Stephen (University of BradfordSchool of Health Studies, 2010-06-08)Home physiotherapy is a valid service option for the patient who was recently discharged from hospital after sustaining a stroke, as it enhances functional independence in friendly and familiar surroundings, as opposed to an outpatient clinic (Bader 2008). The aim of this study was to investigate the system responses to the planning and implementation of a home physiotherapy service as an innovation within the Maltese Public Health Service, uncovering barriers or constraints that influenced the introduction and development of state-run home physiotherapy in Malta. Method A qualitative approach was used for this research. A case study design was selected because it possessed contextual, descriptive and heuristic characteristics. Study participants planned and implemented the service using the available resources. Policy makers, physiotherapists, stroke patients and caregivers contributed to the study through their responses to, and experiences of, this service innovation. It was both an exploration and an opportunity to learn about service innovation from a Maltese perspective. A group of stakeholders were interviewed during the planning stage (Phase 1) of the home physiotherapy service. The main purpose of these interviews was to inform the design of the service. Another group of participants was interviewed in the active service stage (Phase 2) - at the beginning and at the end. The purpose here was to gather data from their direct experiences with home physiotherapy. Documents relevant to home rehabilitation were accessed and analysed hermeneutically. These included newspaper media, as it was considered a sensitive instrument to understand social context (Catalán Matamoros 2007; Davis 1990). Findings and discussion Data analysis identified categories of findings such as ¿barriers to the implementation of a new service¿, ¿attitudes to home physiotherapy¿ and ¿fragmented rehabilitation service¿. The category components were discussed and linked to the hermeneutical analysis of documents, offering a deeper understanding of the categories within the local context, and revealing a reinforcement of establishment-based health care. Conclusion The findings of this study provided an insight into the constraints that would appear if home physiotherapy, indeed home rehabilitation, were introduced by the Maltese Public Health Service. This research had an impact on the state physiotherapy services. Recommendations to help mitigate the constraints in an overarching manner were offered at the end of the thesis. To the international reader with experience in organised home physiotherapy, this study gives a glimpse into how issues that would seem trivial and obvious at first glance become significant challenges¿.challenges that the uninitiated would need to overcome.