1
|
Sirisena M, Lhussier M, Kaner E, Wearn A, Gray J, James R, Redgate S. 'The book's a conversation starter': a realist exploration of the salutogenic potential of reading for pleasure. Med Humanit 2024:medhum-2023-012880. [PMID: 38688706 DOI: 10.1136/medhum-2023-012880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
Reading for Wellbeing (RfW) is a pilot initiative, aimed at improving mental health and well-being through supporting access and increasing opportunities to read for pleasure. RfW was implemented across six North-East local authorities in England and employed Community Reading Workers to support access to books and reading for targeted populations. The current study used realist methodology to understand context, potential mechanisms of action, acceptability and reported outcomes. Data generation and analysis were conducted iteratively, using focus groups, interviews and observations.The analysis of the collated data highlighted that a positive attitude towards reading and a desire for social connections were significant motivators for engagement with RfW. This paper postulates eight programme theories relating to that context, which describe key mechanisms within RfW linked to engagement with reading, well-being, connections and practice. The paper concludes that previous notions of positivity associated with reading for pleasure enable participants to experience RfW as a positive social encounter. This positive social encounter enhances participants' multiple resistance resources such as increased sense of self-efficacy and connectedness that could impact on their sense of well-being.
Collapse
Affiliation(s)
- Mihirini Sirisena
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Monique Lhussier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Wearn
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Gray
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Rebecca James
- Office for Health Improvement and Disparities, London, UK
| | - Sam Redgate
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Wearn A, Shepherd L. Determinants of routine cervical screening participation in underserved women: a qualitative systematic review. Psychol Health 2024; 39:145-170. [PMID: 35296200 DOI: 10.1080/08870446.2022.2050230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Routine, population-wide cervical screening programmes reduce cervical cancer incidence and mortality. However, socioeconomically deprived communities and ethnic minority groups typically have lower uptake in comparison to the general population and thus are described as 'underserved.' A systematic qualitative literature review was conducted to identify relevant determinants of participation for these groups. METHODS Online databases were searched for relevant literature from countries with well-established, call-recall screening programmes. Overall, 24 articles were eligible for inclusion. Data was synthesized via Framework synthesis. Dahlgren & Whitehead's social model of health was used as a broad a priori coding framework. RESULTS Participation was influenced by determinants at multiple levels. Overall, patient-provider relationships and peer support facilitated engagement. Cultural disparities, past healthcare experience and practical barriers hindered service access and exacerbated negative thoughts, feelings and attitudes towards participation. Complex interrelationships between determinants suggest barriers have a cumulative effect on screening participation. CONCLUSIONS These findings present a framework of psychosocial determinants of cervical screening uptake in underserved women and emphasise the role of policy makers and practitioners in reducing structural barriers to screening services. Additional work, exploring the experience of those living within socioeconomically disadvantaged areas, is needed to strengthen understanding in this area.
Collapse
Affiliation(s)
- Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Lee Shepherd
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle Upon Tyne, UK
| |
Collapse
|
3
|
Desai B, Carrigan N, Wearn A, Blackman J, Ben Yehuda M, Young S, Koychev I, Coulthard E. Exploring the association between sleep and cognitive performance in a healthy and real-world cognitively impaired population. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Isotalus H, Wearn A, Selwood J, Bartsch U, Durant C, Jones M, Kauppinen R, Coulthard E. Sleep architecture and hippocampal subfields in healthy older adults. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
5
|
Brennan-Tovey K, Aquino MRJ, Flanagan S, Kaner E, Wearn A, Bigirumurame T, Fong M, Todd A, Aveyard P, Jolly K, Damery S, Attwood A, Robson D, West J, Bridges S, Armitage CJ, Russell S, Strong S, Ramsay SE. Implementation of the NHS-funded tobacco dependence services in England: a qualitative study to understand the contexts of implementation. Lancet 2022; 400 Suppl 1:S24. [PMID: 36929967 DOI: 10.1016/s0140-6736(22)02234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Health Service (NHS) Long Term Plan is a national policy that offers a package of treatment and support, called the NHS-funded tobacco dependence service, to help people stop smoking. It will be offered to people who smoke and are admitted to hospital by 2023-24. We present preliminary findings from our study, aiming to describe the contexts that the NHS-funded tobacco dependence services is being implemented in, including current service provisions. METHODS We did a qualitative study in five regions across England to understand the current provision and context implementing the NHS-funded tobacco dependence services, including current barriers to a quality service, and challenges of implementing the new service. We used key informant technique and document analysis. We interviewed those involved in the planning, commissioning, or delivery of NHS-funded tobacco dependence services. Documents analysed included implementation plans. Interviews and documents were analysed thematically. Ethical approval was obtained from Newcastle University. FINDINGS At time of writing (May 25, 2022), 11 interviews had been done, conducted by KBT and SF, and 12 documents analysed (Integrated Care System implementation plans, hospital trust polices, and protocols). Preliminary findings show that pre-existing services were patchy across regions, trusts, and patient pathways, whereas referrals to Local Authority Stop Smoking Services and community pharmacies differed between regions. Current practices to identify smokers within NHS settings were inadequate, with many smokers being discharged with no nicotine replacement therapy. Barriers to implementing the NHS Long Term Plan included funding issues, engagement of trusts, and a hesitancy to change. Participants identified anticipated changes being a reduction in health inequalities, reducing stigma, and a change in staff perception of smoking. INTERPRETATION Our findings show how funding, trust interest and systems, current services, infrastructure, and attitudes and culture of staff pose challenges and barriers to the successful implementation of the NHS Long Term Plan, locally and nationally. These findings will provide a detailed insight into the plans implementation challenges to policy and practice partners, as well as hopefully guide them on how to overcome these challenges. FUNDING NIHR's National Priority Areas Research Programme 2020-23 via the Prevention Including Behavioural Risk Factors Applied Research Collaboration (ARC) Consortium.
Collapse
Affiliation(s)
- Kerry Brennan-Tovey
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Flanagan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Theophile Bigirumurame
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mackenzie Fong
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adam Todd
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Angela Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Debbie Robson
- National Addiction Centre, Kings College London, London, UK
| | - Jane West
- Bradford institute for Health Research, Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sally Bridges
- Bradford institute for Health Research, Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Samantha Russell
- National Institute for Health and Care Research Applied Research Collaboration North East and North Cumbria Tobacco Evaluation Public Advisory Group, Newcastle, UK
| | - Steve Strong
- National Institute for Health and Care Research Applied Research Collaboration North East and North Cumbria Tobacco Evaluation Public Advisory Group, Newcastle, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
6
|
Rodrigues AM, Wearn A, Haste A, Mallion V, Evison M, Howle F, Haighton C. Understanding the implementation strategy of a secondary care tobacco addiction treatment pathway (the CURE project) in England: a strategic behavioural analysis. BMJ Open 2022; 12:e054739. [PMID: 35701059 PMCID: PMC9198791 DOI: 10.1136/bmjopen-2021-054739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 05/08/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project implemented an evidence-based intervention that offers a combination of pharmacotherapy and behavioural support to tobacco-dependent inpatients. Understanding key characteristics of CURE's implementation strategy, and identifying areas for improvement, is important to support the roll-out of nationwide tobacco dependence services. This study aimed to (1) specify key characteristics of CURE's exiting implementation strategy and (2) develop theoretical-informed and stakeholder-informed recommendations to optimise wider roll-out. DESIGN AND METHODS Data were collected via document review and secondary analysis of interviews with 10 healthcare professionals of a UK hospital. Intervention content was specified through behaviour change techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A logic model was developed to specify CURE's implementation strategy and its mechanisms of impact. We explored the extent to which BCTs and intervention functions addressed the key theoretical domains influencing implementation using prespecified matrices. The development of recommendations was conducted over a two-round Delphi exercise. RESULTS We identified six key theoretical domains of influences: 'environmental context and resources', 'goals', 'social professional role and identity', 'social influences', 'reinforcement' and 'skills'. The behavioural analysis identified 26 BCTs, 4 intervention functions and 4 policy categories present within the implementation strategy. The implementation strategy included half the relevant intervention functions and BCTs to target theoretical domains influencing CURE implementation, with many BCTs focusing on shaping knowledge. Recommendations to optimise content were developed following stakeholder engagement. CONCLUSIONS CURE offers a strong foundation from which a tobacco dependence treatment model can be developed in England. The exiting strategy could be strengthened via the inclusion of more theoretically congruent BCTs, particularly relating to 'environmental context and resources'. The recommendations provide routes to optimisation that are both theoretically grounded and stakeholder informed. Future research should assess the feasibility/acceptability of these recommendations in the wider secondary-care context.
Collapse
Affiliation(s)
- Angela M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Angela Wearn
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Haste
- Centre for Applied Psychological Science, Department of Psychology, School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Verity Mallion
- Behavioural Insights Team, Public Health England, London, UK
| | - Matthew Evison
- The CURE Project Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Freya Howle
- The CURE Project Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| |
Collapse
|
7
|
Wearn A, Haste A, Haighton C, Mallion V, Rodrigues AM. Barriers and facilitators to implementing the CURE stop smoking project: a qualitative study. BMC Health Serv Res 2021; 21:481. [PMID: 34016109 PMCID: PMC8136754 DOI: 10.1186/s12913-021-06504-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals' implementation behaviour within the pilot site. METHODS Individual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development. RESULTS Eight TDF domains were identified as important areas influencing CURE implementation; 'environmental context and resources' (physical opportunity), 'social influence' (social opportunity), 'goals', 'professional role and identity' and 'beliefs about consequences' (reflective motivation), 'reinforcement' (automatic motivation), 'skills' and 'knowledge' (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of 'beliefs about consequences' and 'knowledge', which were highlighted as facilitators of CURE. Participants suggested that 'environmental context and resources' was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context. CONCLUSIONS This qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts.
Collapse
Affiliation(s)
- Angela Wearn
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK.
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 4AX, UK.
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK.
| | - Anna Haste
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Catherine Haighton
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Coach lane Campus West, Newcastle upon Tyne, NE7 7XA, UK
| | - Verity Mallion
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Angela M Rodrigues
- Department of Psychology, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK
- Fuse: UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| |
Collapse
|
8
|
Affiliation(s)
- Angela Wearn
- Department of Psychology Northumbria University Newcastle Upon Tyne UK
| | - Lee Shepherd
- Department of Psychology Northumbria University Newcastle Upon Tyne UK
| |
Collapse
|
9
|
Wearn A, Gray M, Gill P, Ewan MA, Sandhu P, Rajaei-Dehkordi Z. A postal survey to assess the views of community pharmacists on the deregulation of emergency hormonal contraception. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2001.tb01118.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Focal points
Collapse
Affiliation(s)
- A Wearn
- Department of General Practice, University of Birmingham
| | - M Gray
- Pharmacy Alliance (a division of Unichem Ltd)
| | - P Gill
- Department of General Practice, University of Birmingham
| | - M A Ewan
- Pharmacy Alliance (a division of Unichem Ltd)
| | - P Sandhu
- Pharmacy Alliance (a division of Unichem Ltd)
| | | |
Collapse
|
10
|
Wearn A, Bhoopatkar H. Clinical skills centres: where did we come from? Med Educ 2005; 39:1078. [PMID: 16178838 DOI: 10.1111/j.1365-2929.2005.02274.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
11
|
Heatley V, Delaney BC, Wilson S, Roalfe A, Roberts L, Wearn A, Hobbs FDR, Smith MJL. H pylori testing and endoscopy for dyspepsia in primary care. West J Med 2001. [DOI: 10.1136/bmj.323.7308.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Delaney BC, Wilson S, Roalfe A, Roberts L, Redman V, Wearn A, Hobbs FD. Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care. BMJ 2001; 322:898-901. [PMID: 11302905 PMCID: PMC30588 DOI: 10.1136/bmj.322.7291.898] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the cost effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia. DESIGN Randomised controlled trial. SETTING 31 UK primary care centres. PARTICIPANTS 478 patients under 50 years old presenting with dyspepsia of longer than four weeks duration. INTERVENTIONS Near patient testing for H pylori and open access endoscopy for patients with positive results. Control patients received acid suppressing drugs or specialist referral at general practitioner's discretion. MAIN OUTCOME MEASURES Cost effectiveness based on improvement in symptoms and use of resources at 12 months; quality of life. RESULTS 40% of the study group tested positive for H pylori. 45% of study patients had endoscopy compared with 25% of controls. More peptic ulcers were diagnosed in the study group (7.4% v 2.1%, P=0.011). Paired comparison of symptom scores and quality of life showed that all patients improved over time with no difference between study and control groups. No significant differences were observed in rates of prescribing, consultation, or referral. Costs were higher in the study group ( 367.85 pound sterling v 253.16 pound sterling per patient). CONCLUSIONS The test and endoscopy strategy increases endoscopy rates over usual practice in primary care. The additional cost is not offset by benefits in symptom relief or quality of life.
Collapse
Affiliation(s)
- B C Delaney
- Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational Health, University of Birmingham Medical School, Birmingham B15 2TT, UK.
| | | | | | | | | | | | | |
Collapse
|
13
|
Delaney BC, Wilson S, Roalfe A, Roberts L, Redman V, Wearn A, Briggs A, Hobbs FD. Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care. Lancet 2000; 356:1965-9. [PMID: 11130524 DOI: 10.1016/s0140-6736(00)03308-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dyspepsia can be managed by initial endoscopy and treatment based on endoscopic findings, or by empirical prescribing. We aimed to determine the cost effectiveness of initial endoscopy compared with usual management in patients with dyspepsia over age 50 years presenting to their primary care physician. METHODS 422 patients were recruited and randomly assigned to initial endoscopy or usual management. Primary outcomes were effect of treatment on dyspepsia symptoms and cost effectiveness. Secondary outcomes were quality of life and patient satisfaction. Total costs were calculated from individual patient's use of resources with unit costs applied from national data. Statistical analysis of uncertainty on incremental cost-effectiveness ratio (ICER) was done along with a sensitivity analysis on unit costs with cost-effectiveness acceptability curves. FINDINGS In the 12 months following recruitment, 213 (84%) patients had an endoscopy compared with 75 (41%) controls. Initial endoscopy resulted in a significant improvement in symptom score (p=0.03), and quality of life pain dimension (p=0.03), and a 48% reduction in the use of proton pump inhibitors (p=0.005). The ICER was Pound Sterling1728 (UK Pound Sterling) per patient symptom-free at 12 months. The ICER was very sensitive to the cost of endoscopy, and could be reduced to Pound Sterling165 if the unit cost of this procedure fell from Pound Sterling246 to Pound Sterling100. INTERPRETATION Initial endoscopy in dyspeptic patients over age 50 might be a cost-effective intervention.
Collapse
Affiliation(s)
- B C Delaney
- Department of Primary Care and General Practice, University of Birmingham, Medical School, Edgbaston.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Skelton J, Wearn A. The costs of teaching. Med Educ 1999; 33:64-65. [PMID: 10211281 DOI: 10.1046/j.1365-2923.1999.0359c.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|