Deprivation, demography, and the distribution of general practice:

Asthana, Sheena; Gibson, Alex

doi:10.3399/bjgp08x342372

Cited by 24 publications

(23 citation statements)

References 28 publications

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“…Yet PCTs serving the oldest populations, many of which have the highest rates of both mortality and chronic disease (e.g. as measured using Quality and Outcomes Framework data), have received significantly lower per capita allocations than the PCTs serving younger, more deprived populations with lower overall rates of mortality and chronic disease [18].…”

Section: Existing Health Care Utilisation In the English Nhs: A Suitamentioning

confidence: 99%

Setting health care capitations through diagnosis-based risk adjustment: A suitable model for the English NHS?

Asthana

Gibson

2011

Health Policy

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Section: Existing Health Care Utilisation In the English Nhs: A Suitamentioning

confidence: 99%

Setting health care capitations through diagnosis-based risk adjustment: A suitable model for the English NHS?

Asthana

Gibson

2011

Health Policy

Self Cite

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“…15 The deleterious effects of deprivation on health have been well chronicled, 16,17 but it is only recently that excess demands generated by wealth have been debated. 18,19 I needn't look too far for an obvious example. The prosperous areas of Hertfordshire and Buckinghamshire in which I practice have long been coveted by migrating Londoners, for whom economic pragmatism dictates they can stretch but not sever their links with the capital, into which the majority of working age residents commute.…”

Section: The Rise Of the Medical Mcjobmentioning

confidence: 99%

The rise of the medical McJob: why weshouldturn the clock back

Lakasing¹

2009

Br J Gen Pract

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“…[193][194][195] In order to establish the best way to approach practices across England, we consulted the PCAG, which provided us with helpful insights into the best way to recruit practices to endorse the pre-invitation. The five NHS BCSP hub directors also provided feedback on recruitment materials developed by the research team.…”

Section: Recruitment Of General Practices To Endorse the Screening Offermentioning

confidence: 99%

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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Deprivation, demography, and the distribution of general practice:

Cited by 24 publications

References 28 publications

Setting health care capitations through diagnosis-based risk adjustment: A suitable model for the English NHS?

Setting health care capitations through diagnosis-based risk adjustment: A suitable model for the English NHS?

The rise of the medical McJob: why weshouldturn the clock back

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

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