Bernadette Khoshaba | King's College London (original) (raw)

Papers by Bernadette Khoshaba

Oxford Handbook of Public Health Practice, 2006

The 2000 World Health Report (WHR2000) identifi ed three fundamental goals for a health system: i... more The 2000 World Health Report (WHR2000) identifi ed three fundamental goals for a health system: improving the health of the population it serves; responding to the reasonable expectations of that population; and collecting funds to do so in a way that is fair (WHO, 2000). In this chapter, we focus on the fi rst of these: improving population health. Before doing so, however, we summarize briefl y the work that has taken place on this issue so far. The authors of the WHR2000 faced a challenge. They were required to estimate performance for all 191 of the WHO Member States, of which only about 60 had any data on causes of death. Consequently, the only measure of population health outcomes available to them was mortality, and even then it was necessary to produce estimates for many countries, based on empirical relationships with other measures, such as economic status (McKee, 2010). This determined their chosen defi nition of the health system, which they decided would include "all activities, whose primary purpose is to promote, restore and maintain health". The actual indicator used was disability-adjusted life years, which incorporated a measure of morbidity, but again this was estimated for most countries. This approach was the only one possible given the need to include so many countries. Although controversial, it has served as a basis for many of the subsequent developments in assessing health systems performance. It was also consistent with a considerable body of previous research on the performance of countries worldwide that had also used mortality-based measures of health outcome (although more often infant and under-fi ve mortality), which are available from Demographic and Health Surveys for many countries without vital registration systems.

International Journal of Public Health, 2013

Although the contribution of health care to survival from cancer has been studied extensively, mu... more Although the contribution of health care to survival from cancer has been studied extensively, much less is known about its contribution to population health. We examine how medical innovations have influenced trends in cause-specific mortality at the national level. Based on literature reviews, we selected six innovations with proven effectiveness against cervical cancer, Hodgkin's disease, breast cancer, testicular cancer, and leukaemia. With data on the timing of innovations and cause-specific mortality (1970-2005) from seven European countries we identified associations between innovations and favourable changes in mortality. For none of the five specific cancers, sufficient evidence for an association between introduction of innovations and a positive change in mortality could be found. The highest association was found between the introduction of Tamoxifen and breast cancer mortality. The lack of evidence of health care effectiveness may be due to gradual improvements in treatment, to effects limited to certain age groups or cancer subtypes, and to contemporaneous changes in cancer incidence. Research on the impact of health care innovations on population health is limited by unreliable data on their introduction.

Rheumatology, 2005

Die Zeitschrift Scientia Pharmaceutica (www.scipharm.at) erscheint vierteljährlich jeweils am End... more Die Zeitschrift Scientia Pharmaceutica (www.scipharm.at) erscheint vierteljährlich jeweils am Ende jedes Quartals eines Jahres. Sie ist ein Medium zur Publikation von Übersichtsarbeiten, Originalarbeiten und Kurzmitteilungen aus allen wissenschaftlichen Disziplinen der Pharmazie und angrenzenden Gebieten sowie der pharmazeutischen Praxis.

European Journal of Public Health, 2011

Annals of the Rheumatic Diseases, 2004

The iterative convergence of the P 1 radiation model can be slow in optically thin scenarios when... more The iterative convergence of the P 1 radiation model can be slow in optically thin scenarios when employing classical iterative methods. In order to remedy this shortcoming, an inhouse P 1 radiation model was interfaced with high performance, scalable, linear solver libraries. Next, the accuracies of P 1 radiation model calculations was assessed by comparing its predictions against discrete ordinates (DO) model calculations for prototypical problems representative of modern combustion systems. Corresponding benchmark results were also included for comparison. Utilizing Pre-Conditioners (PC) to the Conjugate Gradients (CG) method, the convergence time of the P 1 radiation model reduced by a factor of 30 for modest problem sizes and a factor of 70 for larger sized problems when compared against classical Gauss Seidel sweeps. Further, PC provided 50% computational savings compared to employing CG in a standalone mode. The P 1 model calculation times were about 25-30% of the DO model calculation time. The time to solution also scaled linearly with an increase in problem size. The weighted sum of gray gases model employed in this study in conjunction with the P 1 model provided good agreement against benchmark data with L 2 error norms (defined relative to corresponding DO calculations) improving when isotropic intensities were prevalent.

The European health psychologist, 2016

Background In England, a national programme of health checks to identify cardiovascular disease r... more Background In England, a national programme of health checks to identify cardiovascular disease risk is being rolled out, but encountering difficulties with low uptake. This trial examined whether an enhanced invitation method, using the question-behaviour effect (QBE), with or without offering a financial incentive for returning the QBE questionnaire, increased uptake of health checks. Methods: Three-arm randomised trial (ISRCTN42856343). All individuals (n=12,459) invited for health checks from 18 general practices in London were randomised to either: (i) standard invitation only, ii) QBE questionnaire (Theory of Planned Behaviour and anticipated regret items) followed by standard invitation; iii) QBE questionnaire with financial incentive offered for questionnaire return, followed by standard invitation. The primary outcome, a completed health check, was objectively assessed from electronic health records. Outcome data was available for 12,052 participants. Findings Health check ...

Digestive Diseases and Sciences, 2020

Background Inflammatory Bowel Disease (IBD) causes interrelated symptoms of fatigue, pain and urg... more Background Inflammatory Bowel Disease (IBD) causes interrelated symptoms of fatigue, pain and urgency which can persist in remission. Aim To understand how people with IBD experience and self-manage these symptoms, to inform the future development of an online self-management programme. Methods Using exploratory qualitative methods, we recruited participants from clinic and community settings. Focus groups, conducted across the UK, were audio recorded and professionally transcribed. Transcripts were analysed over four rounds using framework analysis. Eight patients were consulted to agree the final structure of data and themes. Results Seven focus groups were held; five gave useable data. Twenty-six participants (15 female; ages 21-60 years; disease duration 2-40 years) with Crohn's Disease (n=10), ulcerative colitis (n=14) and IBD-Unclassified (n=2) attended one of these five focus groups. Three core themes emerged: The Negative Impact of Symptoms, Positively Taking Control, and Seeking and Receiving Support. The persistent, often stark impact of multiple co-existing symptoms on physical and emotional wellbeing can force unwanted adjustments and limitations in working, social and intimate arenas of life. Unpredictable symptoms are challenging and impact each other in negative vicious cycles. Managing diet, pacing, accepting background levels of fatigue, pain and urgency, seeking support, exercising and attending to mental wellbeing, are all perceived as helpful in self-managing symptoms. Conclusion Fatigue, pain, and urgency are troublesome for patients, especially in combination, suggesting that these should be addressed simultaneously by clinicians. Participants reported several strategies for self-management, providing patient-focused evidence to inform future development of a self-management intervention programme.

Journal of Crohn's and Colitis, 2019

at recruitment and at Week 14 were used to assess the impact of the IBD-nurse care. Results: A to... more at recruitment and at Week 14 were used to assess the impact of the IBD-nurse care. Results: A total of 76 patients were recruited over 8 months' period, of whom 34 patients completed 14 weeks follow-up after biologic therapy initiation. Age, baseline C-reactive protein, haemoglobin and faecal calprotectin levels and types of biologics did not differ between the standard and intensified groups at baseline. Uncertainty scores significantly improved within each group at Week 14: ∆ in the standard group-0.428 (IQR 0.515 −0.767), p = 0.001, and ∆ in the intensified group-0.428 (IQR 0.089-0.767), p = 0.002. The domains regulating defaecation and emotions were stable throughout the follow-up period in the intensified group but have deteriorated in the standard group (∆

Scandinavian Journal of Gastroenterology, 2018

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 31, 2018

Uptake of health checks for cardiovascular risk assessment in primary care in England is lower th... more Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within...

Journal of public health (Oxford, England), Jan 17, 2017

A population-based programme of health checks has been established in England. Participants recei... more A population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call-recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for 'invited' and 'opportunistic' health checks. Cohort study of all health checks completed at 18 general practices from July 2013 to June 2015. For each general practice, cardiovascular (CVD) risk scores were compared by source of check and pooled using meta-analysis. Effect estimates were compared by gender, age-group, ethnicity and fifths of deprivation. There were 6184 health checks recorded (2280 invited and 3904 opportunistic) with CVD risk scores recorded for 5359 (87%) participants. There were 17.0% of invited checks and 22.2% of opportunistic health checks with CVD risk score ≥10%; a relative increment of 28% (95% confidence interval: 14-44%, P < 0.001). In the most deprived quint...

Health Technology Assessment, 2016

BackgroundA national programme of health checks to identify risk of cardiovascular disease (CVD) ... more BackgroundA national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake.ObjectiveTo evaluate the effectiveness of an enhanced invitation method using the question–behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks.DesignThree-arm randomised trial and cohort study.ParticipantsAll participants invited for a health check from 18 general practices. Individual participants were randomised.Interventions(1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation.Main outcome measuresThe...

Rheumatology (Oxford, England), 2005

Trials of disease-modifying anti-rheumatic drugs (DMARDs) enrol active rheumatoid arthritis patie... more Trials of disease-modifying anti-rheumatic drugs (DMARDs) enrol active rheumatoid arthritis patients identified using standard criteria (three out of four of: >/=6 tender joints, >/=6 swollen joints, ESR >/= 28 mm/h, >/=45 min morning stiffness). Concern has been expressed about generalizability, as many patients in routine practice have less active disease. Furthermore, these criteria do not map onto standard disease activity and treatment response measures. We examined how many routine patients were sufficiently active to meet trial recruitment criteria and whether alternative definitions of active disease were more appropriate. We studied 504 patients in a cross-sectional study, 156 in a longitudinal study and 94 starting new DMARDs or biologics. Patients were classified as 'trial active' (met entry criteria), in remission or 'intermediately active' (between the two). We also evaluated the effect of amendments to criteria. Cross-sectionally only 38% pa...

International Journal of Pharmacy Practice, 2013

Objectives Prescriptions for medicines issued by healthcare professionals in other parts of the E... more Objectives Prescriptions for medicines issued by healthcare professionals in other parts of the European Union are legally valid in the UK. However, it is not known whether this is fully understood by British community pharmacists. In this study we aimed to understand the implementation of UK pharmacy policy on dispensing prescriptions from other parts of the European Union and to investigate pharmacists' knowledge and interpretation of the relevant provisions in a mystery shopping exercise in English pharmacies. Methods We reviewed the policy literature on regulations and practices pertaining to the prescribing and dispensation of prescription-only medicines in the UK. We interviewed key English informants in pharmacy. We then conducted a 'mystery shopping' exercise in 60 randomly selected pharmacies in urban, peri-urban and rural areas of England to investigate how community pharmacists manage four different types of prescriptions from another EU country. Key findings From the eight interviews conducted there was broad consensus that existing processes for verifying the authenticity of foreign prescriptions could be improved. Of the 60 pharmacies visited, only 27% (16 out of 60) were willing to dispense the medication. Pharmacists unwilling to dispense were invited to explain their reasons for refusal. The most common were that they believed that English pharmacists are unauthorised to dispense foreign prescriptions, and that prescriptions must be in the English language or issued by a UK-recognised prescriber. Conclusion Existing processes available to English pharmacists for verifying the authenticity of foreign prescriptions seem to be insufficient. Strategies to overcome these problems were proposed by pharmacists and key informants, and include the creation of a database or registry of all authorised European Economic Area/Swiss prescribers, development of EU standards on prescription content and on dosage of medications, consistent international non-proprietary name (INN) prescribing and the use of an agreed common language for key information on prescriptions.

Gaceta Sanitaria, 2013

Objectives: There is a renewed interest in health system indicators. In 1976 a measure of quality... more Objectives: There is a renewed interest in health system indicators. In 1976 a measure of quality of healthcare, amenable mortality, was introduced by Rutstein. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective healthcare. In the project "Amenable mortality in the European Union: toward better indicators for the effectiveness of health systems" (AMIEHS), we introduce a new approach to the selection of indicators of amenable mortality. Methods: Based on predefined selection criteria and a broad review of the literature on the effectiveness of medical interventions, a first set of potential indicators of amenable mortality (causes of death) was selected. The timing of the introduction of medical innovations was established through reviews and questionnaires sent to national experts from seven participating European countries. The preselected indicators were then validated by a trend analysis that identified associations between the timing of innovations and cause-specific mortality trends and by a Delphi-procedure. Results: After a short review of previous lists of amenable mortality indicators and a detailed description of the innovative procedure in the AMIEHS project we present a list of 14 causes of death that passed our selection criteria. We illustrate our empirical validation of these indicators using the examples of peptic ulcer and renal failure. Conclusions: The innovation developed in the AMIEHS study is a rigorous new approach to the concept of amenable mortality that includes empirical validation. Only validated indicators can be successfully used to assess the quality of healthcare systems in international comparisons.

Rheumatology, 2006

Objective. We determined the amount of fatigue experienced by patients with RA, and its relations... more Objective. We determined the amount of fatigue experienced by patients with RA, and its relationship to synovitis, pain and other common clinical features. We also examined to what extent RA fatigue is improved by disease-modifying antirheumatic drugs (DMARDs) and anti-tumour necrosis factor (TNF) therapy. Methods. We studied two cohorts of 238 and 274 RA patients cross-sectionally and examined treatment responses in 30 RA patients starting anti-TNF and 54 starting DMARDs followed for 3 and 6 months. We measured fatigue using visual analogue scores (VAS) and Medical Outcomes Study Short Form 36 (SF-36) vitality scores. We recorded the disease activity score for 28 joints and its components (tender/swollen joint counts, patient global assessment, ESR), morning stiffness, health assessment questionnaire, physician global assessment, erosive disease, nodules, rheumatoid factor, concomitant medications and illnesses, and the SF-36 questionnaire. Results. Fatigue was common in RA patients; over 80% had clinically relevant fatigue (VAS¸20 mm), over 50% had high levels (VAS¸50 mm). It was associated with pain and changes in mental health, particularly depression. In each of the two cross-sectional cohorts, this relationship was similar whichever measures of fatigue and mental health were used. Fatigue fell with DMARDs and anti-TNF: before treatment, 87% of patients had high fatigue, after treatment this fell to 50%. These treatment effects were mainly linked to improvements in pain. Conclusions. High fatigue levels characterize RA and are mainly linked to pain and depression. The association with disease activity is secondary. Fatigue falls with DMARD and anti-TNF therapy. The balance of evidence suggests that fatigue is centrally mediated in established RA.

Oxford Handbook of Public Health Practice, 2006

The 2000 World Health Report (WHR2000) identifi ed three fundamental goals for a health system: i... more The 2000 World Health Report (WHR2000) identifi ed three fundamental goals for a health system: improving the health of the population it serves; responding to the reasonable expectations of that population; and collecting funds to do so in a way that is fair (WHO, 2000). In this chapter, we focus on the fi rst of these: improving population health. Before doing so, however, we summarize briefl y the work that has taken place on this issue so far. The authors of the WHR2000 faced a challenge. They were required to estimate performance for all 191 of the WHO Member States, of which only about 60 had any data on causes of death. Consequently, the only measure of population health outcomes available to them was mortality, and even then it was necessary to produce estimates for many countries, based on empirical relationships with other measures, such as economic status (McKee, 2010). This determined their chosen defi nition of the health system, which they decided would include "all activities, whose primary purpose is to promote, restore and maintain health". The actual indicator used was disability-adjusted life years, which incorporated a measure of morbidity, but again this was estimated for most countries. This approach was the only one possible given the need to include so many countries. Although controversial, it has served as a basis for many of the subsequent developments in assessing health systems performance. It was also consistent with a considerable body of previous research on the performance of countries worldwide that had also used mortality-based measures of health outcome (although more often infant and under-fi ve mortality), which are available from Demographic and Health Surveys for many countries without vital registration systems.

International Journal of Public Health, 2013

Although the contribution of health care to survival from cancer has been studied extensively, mu... more Although the contribution of health care to survival from cancer has been studied extensively, much less is known about its contribution to population health. We examine how medical innovations have influenced trends in cause-specific mortality at the national level. Based on literature reviews, we selected six innovations with proven effectiveness against cervical cancer, Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease, breast cancer, testicular cancer, and leukaemia. With data on the timing of innovations and cause-specific mortality (1970-2005) from seven European countries we identified associations between innovations and favourable changes in mortality. For none of the five specific cancers, sufficient evidence for an association between introduction of innovations and a positive change in mortality could be found. The highest association was found between the introduction of Tamoxifen and breast cancer mortality. The lack of evidence of health care effectiveness may be due to gradual improvements in treatment, to effects limited to certain age groups or cancer subtypes, and to contemporaneous changes in cancer incidence. Research on the impact of health care innovations on population health is limited by unreliable data on their introduction.

Rheumatology, 2005

Die Zeitschrift Scientia Pharmaceutica (www.scipharm.at) erscheint vierteljährlich jeweils am End... more Die Zeitschrift Scientia Pharmaceutica (www.scipharm.at) erscheint vierteljährlich jeweils am Ende jedes Quartals eines Jahres. Sie ist ein Medium zur Publikation von Übersichtsarbeiten, Originalarbeiten und Kurzmitteilungen aus allen wissenschaftlichen Disziplinen der Pharmazie und angrenzenden Gebieten sowie der pharmazeutischen Praxis.

European Journal of Public Health, 2011

Annals of the Rheumatic Diseases, 2004

The iterative convergence of the P 1 radiation model can be slow in optically thin scenarios when... more The iterative convergence of the P 1 radiation model can be slow in optically thin scenarios when employing classical iterative methods. In order to remedy this shortcoming, an inhouse P 1 radiation model was interfaced with high performance, scalable, linear solver libraries. Next, the accuracies of P 1 radiation model calculations was assessed by comparing its predictions against discrete ordinates (DO) model calculations for prototypical problems representative of modern combustion systems. Corresponding benchmark results were also included for comparison. Utilizing Pre-Conditioners (PC) to the Conjugate Gradients (CG) method, the convergence time of the P 1 radiation model reduced by a factor of 30 for modest problem sizes and a factor of 70 for larger sized problems when compared against classical Gauss Seidel sweeps. Further, PC provided 50% computational savings compared to employing CG in a standalone mode. The P 1 model calculation times were about 25-30% of the DO model calculation time. The time to solution also scaled linearly with an increase in problem size. The weighted sum of gray gases model employed in this study in conjunction with the P 1 model provided good agreement against benchmark data with L 2 error norms (defined relative to corresponding DO calculations) improving when isotropic intensities were prevalent.

The European health psychologist, 2016

Background In England, a national programme of health checks to identify cardiovascular disease r... more Background In England, a national programme of health checks to identify cardiovascular disease risk is being rolled out, but encountering difficulties with low uptake. This trial examined whether an enhanced invitation method, using the question-behaviour effect (QBE), with or without offering a financial incentive for returning the QBE questionnaire, increased uptake of health checks. Methods: Three-arm randomised trial (ISRCTN42856343). All individuals (n=12,459) invited for health checks from 18 general practices in London were randomised to either: (i) standard invitation only, ii) QBE questionnaire (Theory of Planned Behaviour and anticipated regret items) followed by standard invitation; iii) QBE questionnaire with financial incentive offered for questionnaire return, followed by standard invitation. The primary outcome, a completed health check, was objectively assessed from electronic health records. Outcome data was available for 12,052 participants. Findings Health check ...

Digestive Diseases and Sciences, 2020

Background Inflammatory Bowel Disease (IBD) causes interrelated symptoms of fatigue, pain and urg... more Background Inflammatory Bowel Disease (IBD) causes interrelated symptoms of fatigue, pain and urgency which can persist in remission. Aim To understand how people with IBD experience and self-manage these symptoms, to inform the future development of an online self-management programme. Methods Using exploratory qualitative methods, we recruited participants from clinic and community settings. Focus groups, conducted across the UK, were audio recorded and professionally transcribed. Transcripts were analysed over four rounds using framework analysis. Eight patients were consulted to agree the final structure of data and themes. Results Seven focus groups were held; five gave useable data. Twenty-six participants (15 female; ages 21-60 years; disease duration 2-40 years) with Crohn's Disease (n=10), ulcerative colitis (n=14) and IBD-Unclassified (n=2) attended one of these five focus groups. Three core themes emerged: The Negative Impact of Symptoms, Positively Taking Control, and Seeking and Receiving Support. The persistent, often stark impact of multiple co-existing symptoms on physical and emotional wellbeing can force unwanted adjustments and limitations in working, social and intimate arenas of life. Unpredictable symptoms are challenging and impact each other in negative vicious cycles. Managing diet, pacing, accepting background levels of fatigue, pain and urgency, seeking support, exercising and attending to mental wellbeing, are all perceived as helpful in self-managing symptoms. Conclusion Fatigue, pain, and urgency are troublesome for patients, especially in combination, suggesting that these should be addressed simultaneously by clinicians. Participants reported several strategies for self-management, providing patient-focused evidence to inform future development of a self-management intervention programme.

Journal of Crohn's and Colitis, 2019

at recruitment and at Week 14 were used to assess the impact of the IBD-nurse care. Results: A to... more at recruitment and at Week 14 were used to assess the impact of the IBD-nurse care. Results: A total of 76 patients were recruited over 8 months' period, of whom 34 patients completed 14 weeks follow-up after biologic therapy initiation. Age, baseline C-reactive protein, haemoglobin and faecal calprotectin levels and types of biologics did not differ between the standard and intensified groups at baseline. Uncertainty scores significantly improved within each group at Week 14: ∆ in the standard group-0.428 (IQR 0.515 −0.767), p = 0.001, and ∆ in the intensified group-0.428 (IQR 0.089-0.767), p = 0.002. The domains regulating defaecation and emotions were stable throughout the follow-up period in the intensified group but have deteriorated in the standard group (∆

Scandinavian Journal of Gastroenterology, 2018

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 31, 2018

Uptake of health checks for cardiovascular risk assessment in primary care in England is lower th... more Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within...

Journal of public health (Oxford, England), Jan 17, 2017

A population-based programme of health checks has been established in England. Participants recei... more A population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call-recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for 'invited' and 'opportunistic' health checks. Cohort study of all health checks completed at 18 general practices from July 2013 to June 2015. For each general practice, cardiovascular (CVD) risk scores were compared by source of check and pooled using meta-analysis. Effect estimates were compared by gender, age-group, ethnicity and fifths of deprivation. There were 6184 health checks recorded (2280 invited and 3904 opportunistic) with CVD risk scores recorded for 5359 (87%) participants. There were 17.0% of invited checks and 22.2% of opportunistic health checks with CVD risk score ≥10%; a relative increment of 28% (95% confidence interval: 14-44%, P < 0.001). In the most deprived quint...

Health Technology Assessment, 2016

BackgroundA national programme of health checks to identify risk of cardiovascular disease (CVD) ... more BackgroundA national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake.ObjectiveTo evaluate the effectiveness of an enhanced invitation method using the question–behaviour effect (QBE), with or without the offer of a financial incentive to return the QBE questionnaire, at increasing the uptake of health checks. The research went on to evaluate the reasons for the low uptake of invitations and compare the case mix for invited and opportunistic health checks.DesignThree-arm randomised trial and cohort study.ParticipantsAll participants invited for a health check from 18 general practices. Individual participants were randomised.Interventions(1) Standard health check invitation only; (2) QBE questionnaire followed by a standard invitation; and (3) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by a standard invitation.Main outcome measuresThe...

Rheumatology (Oxford, England), 2005

Trials of disease-modifying anti-rheumatic drugs (DMARDs) enrol active rheumatoid arthritis patie... more Trials of disease-modifying anti-rheumatic drugs (DMARDs) enrol active rheumatoid arthritis patients identified using standard criteria (three out of four of: >/=6 tender joints, >/=6 swollen joints, ESR >/= 28 mm/h, >/=45 min morning stiffness). Concern has been expressed about generalizability, as many patients in routine practice have less active disease. Furthermore, these criteria do not map onto standard disease activity and treatment response measures. We examined how many routine patients were sufficiently active to meet trial recruitment criteria and whether alternative definitions of active disease were more appropriate. We studied 504 patients in a cross-sectional study, 156 in a longitudinal study and 94 starting new DMARDs or biologics. Patients were classified as 'trial active' (met entry criteria), in remission or 'intermediately active' (between the two). We also evaluated the effect of amendments to criteria. Cross-sectionally only 38% pa...

International Journal of Pharmacy Practice, 2013

Objectives Prescriptions for medicines issued by healthcare professionals in other parts of the E... more Objectives Prescriptions for medicines issued by healthcare professionals in other parts of the European Union are legally valid in the UK. However, it is not known whether this is fully understood by British community pharmacists. In this study we aimed to understand the implementation of UK pharmacy policy on dispensing prescriptions from other parts of the European Union and to investigate pharmacists' knowledge and interpretation of the relevant provisions in a mystery shopping exercise in English pharmacies. Methods We reviewed the policy literature on regulations and practices pertaining to the prescribing and dispensation of prescription-only medicines in the UK. We interviewed key English informants in pharmacy. We then conducted a 'mystery shopping' exercise in 60 randomly selected pharmacies in urban, peri-urban and rural areas of England to investigate how community pharmacists manage four different types of prescriptions from another EU country. Key findings From the eight interviews conducted there was broad consensus that existing processes for verifying the authenticity of foreign prescriptions could be improved. Of the 60 pharmacies visited, only 27% (16 out of 60) were willing to dispense the medication. Pharmacists unwilling to dispense were invited to explain their reasons for refusal. The most common were that they believed that English pharmacists are unauthorised to dispense foreign prescriptions, and that prescriptions must be in the English language or issued by a UK-recognised prescriber. Conclusion Existing processes available to English pharmacists for verifying the authenticity of foreign prescriptions seem to be insufficient. Strategies to overcome these problems were proposed by pharmacists and key informants, and include the creation of a database or registry of all authorised European Economic Area/Swiss prescribers, development of EU standards on prescription content and on dosage of medications, consistent international non-proprietary name (INN) prescribing and the use of an agreed common language for key information on prescriptions.

Gaceta Sanitaria, 2013

Objectives: There is a renewed interest in health system indicators. In 1976 a measure of quality... more Objectives: There is a renewed interest in health system indicators. In 1976 a measure of quality of healthcare, amenable mortality, was introduced by Rutstein. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective healthcare. In the project "Amenable mortality in the European Union: toward better indicators for the effectiveness of health systems" (AMIEHS), we introduce a new approach to the selection of indicators of amenable mortality. Methods: Based on predefined selection criteria and a broad review of the literature on the effectiveness of medical interventions, a first set of potential indicators of amenable mortality (causes of death) was selected. The timing of the introduction of medical innovations was established through reviews and questionnaires sent to national experts from seven participating European countries. The preselected indicators were then validated by a trend analysis that identified associations between the timing of innovations and cause-specific mortality trends and by a Delphi-procedure. Results: After a short review of previous lists of amenable mortality indicators and a detailed description of the innovative procedure in the AMIEHS project we present a list of 14 causes of death that passed our selection criteria. We illustrate our empirical validation of these indicators using the examples of peptic ulcer and renal failure. Conclusions: The innovation developed in the AMIEHS study is a rigorous new approach to the concept of amenable mortality that includes empirical validation. Only validated indicators can be successfully used to assess the quality of healthcare systems in international comparisons.

Rheumatology, 2006

Objective. We determined the amount of fatigue experienced by patients with RA, and its relations... more Objective. We determined the amount of fatigue experienced by patients with RA, and its relationship to synovitis, pain and other common clinical features. We also examined to what extent RA fatigue is improved by disease-modifying antirheumatic drugs (DMARDs) and anti-tumour necrosis factor (TNF) therapy. Methods. We studied two cohorts of 238 and 274 RA patients cross-sectionally and examined treatment responses in 30 RA patients starting anti-TNF and 54 starting DMARDs followed for 3 and 6 months. We measured fatigue using visual analogue scores (VAS) and Medical Outcomes Study Short Form 36 (SF-36) vitality scores. We recorded the disease activity score for 28 joints and its components (tender/swollen joint counts, patient global assessment, ESR), morning stiffness, health assessment questionnaire, physician global assessment, erosive disease, nodules, rheumatoid factor, concomitant medications and illnesses, and the SF-36 questionnaire. Results. Fatigue was common in RA patients; over 80% had clinically relevant fatigue (VAS¸20 mm), over 50% had high levels (VAS¸50 mm). It was associated with pain and changes in mental health, particularly depression. In each of the two cross-sectional cohorts, this relationship was similar whichever measures of fatigue and mental health were used. Fatigue fell with DMARDs and anti-TNF: before treatment, 87% of patients had high fatigue, after treatment this fell to 50%. These treatment effects were mainly linked to improvements in pain. Conclusions. High fatigue levels characterize RA and are mainly linked to pain and depression. The association with disease activity is secondary. Fatigue falls with DMARD and anti-TNF therapy. The balance of evidence suggests that fatigue is centrally mediated in established RA.