Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey.

BACKGROUND: Doctor-patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor-patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. AIM: To determine how reported GP-patient communication varies between patients from different ethnic groups, stratified by age and gender. DESIGN AND SETTING: Analysis of data from the English GP Patient Survey from 2012-2013 and 2013-2014, including 1,599,801 responders. METHOD: A composite score was created for doctor-patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. RESULTS: There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP-patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor-patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as 'Any other white'. CONCLUSION: The identification of groups with particularly marked differences in experience of GP-patient communication--older, female, Asian patients and younger 'Any other white' patients--underlines the need for a renewed focus on quality of care for these groups.This work was funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme (RP-PG-0608-10050).This is the final version of the article. It first appeared from the Royal College of General Practitioners via http://dx.doi.org/10.3399/bjgp15X68763

Role of practices and Clinical Commissioning Groups in measures of patient experience: analysis of routine data.

Recent years have seen an increased focus on measuring how people experience health services to ensure that care and treatment is of the highest quality and safety.1 2 Better patient care experiences are associated with better adherence, clinical outcomes and patient safety, and with lower health care utilisation.3 4 In England, the national GP Patient Survey (GPPS) measures patients’ experience of Primary Care.5 As part of an NHS initiative to improve patient experience and facilitate patient-centred care, GPPS scores are currently reported at the level of general practices, Clinical Commissioning Groups (CCGs) and nationally.Not externally funde

Understanding negative feedback from South Asian patients: an experimental vignette study.

OBJECTIVES: In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care. DESIGN: Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP-patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16. SETTING: Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling. PARTICIPANTS: 564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach. MAIN OUTCOME MEASURE: Mean differences in communication score (on a scale of 0-100) between White British and Pakistani participants, estimated from linear regression. RESULTS: Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p55) and where communication was scripted to be poor. CONCLUSIONS: Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.This work was funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme (RP-PG-0608-10050).

Rating Communication in GP Consultations: The Association Between Ratings Made by Patients and Trained Clinical Raters.

Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from "poor" to "very good." Some patients may be inhibited from rating poor communication negatively. Patient evaluations can be useful for measuring relative performance of physicians' communication skills, but absolute scores should be interpreted with caution.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) program (RP-PG-0608-10050).This is the final version of the article. It first appeared from SAGE via http://dx.doi.org/10.1177/107755871667121

Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors.

OBJECTIVES: To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice. DESIGN: Analysis of postal survey of patients' experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices. SETTING: Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey. PARTICIPANTS: 7721 of 15,172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013. MAIN OUTCOME MEASURE: Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models. RESULTS: After control for differences in patients' age, sex, ethnicity, and health status, the proportion of variance in communication scores that was due to differences between doctors (6.4%) was considerably more than that due to practices (1.8%). The findings also suggest that higher performing practices usually contain only higher performing doctors. However, lower performing practices may contain doctors with a wide range of communication scores. CONCLUSIONS: Aggregating patients' ratings of doctors' communication skills at practice level can mask considerable variation in the performance of individual doctors, particularly in lower performing practices. Practice level surveys may be better used to "screen" for concerns about performance that require an individual level survey. Higher scoring practices are unlikely to include lower scoring doctors. However, lower scoring practices require further investigation at the level of the individual doctor to distinguish higher and lower scoring general practitioners.This work was funded by a National Institute for Health Research Programme Grant for Applied Research (NIHR PGfAR) programme (RP-PG-0608-10050). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.This is the final published article. It first appeared at http://www.bmj.com/content/349/bmj.g6034

Supersymmetry discovery potential of the LHC at s=\sqrt{s}=10 and 14 TeV without and with missing ETE_T

We examine the supersymmetry (SUSY) reach of the CERN LHC operating at $\sqrt{s}=10$ and 14 TeV within the framework of the minimal supergravity model. We improve upon previous reach projections by incorporating updated background calculations including a variety of $2\to n$ Standard Model (SM) processes. We show that SUSY discovery is possible even before the detectors are understood well enough to utilize either $E_T^{\rm miss}$ or electrons in the signal. We evaluate the early SUSY reach of the LHC at $\sqrt{s}=10$ TeV by examining multi-muon plus $\ge4$ jets and also dijet events with {\it no} missing $E_T$ cuts and show that the greatest reach in terms of $m_{1/2}$ occurs in the dijet channel. The reach in multi-muons is slightly smaller in $m_{1/2}$, but extends to higher values of $m_0$. We find that an observable multi-muon signal will first appear in the opposite-sign dimuon channel, but as the integrated luminosity increases the relatively background-free but rate-limited same-sign dimuon, and ultimately the trimuon channel yield the highest reach. We show characteristic distributions in these channels that serve to distinguish the signal from the SM background, and also help to corroborate its SUSY origin. We then evaluate the LHC reach in various no-lepton and multi-lepton plus jets channels {\it including} missing $E_T$ cuts for $\sqrt{s}=10$ and 14 TeV, and plot the reach for integrated luminosities ranging up to 3000 fb$^{-1}$ at the SLHC. For $\sqrt{s}=10$ TeV, the LHC reach extends to $m_{gluino}=1.9, 2.3, 2.8$ and 2.9 TeV for $m_{squark}\sim m_{gluino}$ and integrated luminosities of 10, 100, 1000 and 3000 fb$^{-1}$, respectively. For $\sqrt{s}=14$ TeV, the LHC reach for the same integrated luminosities is to m_{gluino}=2.4,\3.1, 3.7 and 4.0 TeV.Comment: 34 pages, 25 figures. Revised projections for the SUSY reach for ab^-1 integrated luminosities, with minor corrections of references and text. 2 figures added. To appear in JHE

Climate and Landscape Factors Associated with Buruli Ulcer Incidence in Victoria, Australia

Background Buruli ulcer (BU), caused by Mycobacterium ulcerans (M. ulcerans), is a necrotizing skin disease found in more than 30 countries worldwide. BU incidence is highest in West Africa; however, cases have substantially increased in coastal regions of southern Australia over the past 30 years. Although the mode of transmission remains uncertain, the spatial pattern of BU emergence in recent years seems to suggest that there is an environmental niche for M. ulcerans and BU prevalence. Methodology/Principal Findings Network analysis was applied to BU cases in Victoria, Australia, from 1981–2008. Results revealed a non-random spatio-temporal pattern at the regional scale as well as a stable and efficient BU disease network, indicating that deterministic factors influence the occurrence of this disease. Monthly BU incidence reported by locality was analyzed with landscape and climate data using a multilevel Poisson regression approach. The results suggest the highest BU risk areas occur at low elevations with forested land cover, similar to previous studies of BU risk in West Africa. Additionally, climate conditions as far as 1.5 years in advance appear to impact disease incidence. Warmer and wetter conditions 18–19 months prior to case emergence, followed by a dry period approximately 5 months prior to case emergence seem to favor the occurrence of BU. Conclusions/Significance The BU network structure in Victoria, Australia, suggests external environmental factors favor M. ulcerans transmission and, therefore, BU incidence. A unique combination of environmental conditions, including land cover type, temperature and a wet-dry sequence, may produce habitat characteristics that support M. ulcerans transmission and BU prevalence. These findings imply that future BU research efforts on transmission mechanisms should focus on potential vectors/reservoirs found in those environmental niches. Further, this study is the first to quantitatively estimate environmental lag times associated with BU outbreaks, providing insights for future transmission investigations.This project was supported by the World Health Organization and the National Institutes of Health and Fogarty International Center (NIH - R01TW007550). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health. R.W. Merritt is gratefully acknowledged for supporting this research as part of NIH grant R01TW007550

Mapping the UK research & innovation landscape: Energy & development

The UK is already a major player in terms of research and innovation into low carbon transitions within the countries of the developing world. However, there are significant opportunities for the UK to enhance its presence within these markets whilst also making a major contribution to meeting international development targets and climate commitments. At the core of the research analysed in the report is that it reflects disparate, research initiatives funded with different research/innovation targets in mind; much latent strength in UK research for low carbon energy for development therefore is implicit in linkage possibilities enhancing systemic effectiveness, particularly by cross-fertilizing innovations taking place in the private sector. Gaps and weaknesses are reflected as much in the lack of collaborative initiatives and ‘siloization’ as in the absence of actual research/funding. The Low Carbon Energy for Development Network (LCEDN) is currently taking the initiative in one aspect of this through the provision of a programme of capacity building and partnership activities to support the development of DfID’s Transforming Energy Access research initiative. What is required of UK energy for development research for the purposes of building a functional system, however, is that the discrete areas of research outlined in this report be re-assembled as coherent, overall research narratives addressing the apparent contradiction of increasing energy access whilst transitioning to the low-carbon economy. Part of this work involves identifying the state and dynamics of UK research capacity in this sector, facilitating greater integration between research funders active in this area, evaluating gaps and key research needs and mapping potential future directions for research interventions and collaborations that build on, and develop, existing UK research capacity. It is expected that this will lead to a range of UK-led energy innovations developed, tested and scaled across developing countries by 2020. The much-needed harmonization of energy access and low carbon transition as a UK research theme however has ultimately to be created out of rethinking research fields from a combination of existing research, plus demand known to be ‘out there’ but which has yet to enter the field of vision of research-funders. This report presents the first part of this work with an overview of current UK research and innovation capacity in a widely defined ‘Energy and International Development’ research area. It identifies key institutions and research centres, thematic areas of excellence, research funding trends over the last decade, emerging research themes plus an overview of grant funding for innovation on the ground. A number of key areas/questions for potential further development of UK research and innovation capacity have been identified and are up for discussion and consultation. The work has been undertaken by LCEDN in partnership with the Knowledge Transfer Network, Energy 4 Impact and IOD PARC