Comparing care at walk-in centres and at accident and emergency departments: an exploration of patient choice, preference and satisfaction

Objectives: To explore the impact of establishing walk-in centres alongside emergency departments on patient choice, preference and satisfaction. Methods: A controlled, mixed-method study comparing eight emergency departments with co-located walk-in centres with the same number of ‘traditional’ emergency departments. This paper focuses on the results of a cross-sectional questionnaire survey of users. Results: Survey data demonstrated that patients were frequently unable to distinguish between being treated at a walk-in centre or an A&E department, and even where this was the case, opportunities to exercise choice about their preferred care provider were often limited. Few made an active choice to attend a co-located walk-in centre. Patients attending walk-in centres were just as likely to be satisfied overall with the care they received as their counterparts who were treated in the co-located A&E facility, although a small proportion of walk-in centre users did report greater satisfaction with some specific aspects of their care and consultation. Conclusions: Whilst one of the key policy goals underpinning the co-location of walk-in centres next to an A&E department was to provide patients with more options for accessing healthcare and greater choice, leading in turn to increased satisfaction, this evaluation was able to provide little evidence to support this. The high percentage of patients expressing a preference for care in an established emergency department compared to a new walk-in centre facility raises questions for future policy development. Further consideration should therefore be given to the role that A&E focused walk-in centres play in the Department of Health’s current policy agenda, as far as patient choice is concerned

An evaluation of advanced access in general practice

Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.Objectives: To describe the range of strategies that general practices have employed to improve access to care To determine the impact of Advanced Access on the wait for an appointment, continuity of care, practice workload, and demand on other NHS services. To explore the perceptions of different groups of patients, including both users and non-users of services, about the accessibility of care and their satisfaction with access to care in relation to different models of organisation. To explore the trade-offs that patients make between speed of access, continuity of care and other factors when making an appointment in general practice. To explore the perceptions of general practitioners and receptionists about working with the NPDT and implementing changes to practice arrangements to improve access. To assess the impact of the above changes in practice organisation on staff job satisfaction and team climate.Method and results: This research was based on a comparison of 48 general practices, half of which operated Advanced Access appointment systems and half of which did not (designated ‘control’ practices). These practices were recruited from 12 representative Primary Care Trusts (PCTs). From within these 48 practices, eight (four Advanced Access and four control) were selected for in-depth case study using an ethnographic approach. The research was comprised of several component studies. These included: • A survey of all practices in 12 PCTs. Based on this we recruited the 24 Advanced Access and 24 control practices and the 8 case study practices. • An assessment of appointments available and patients seen, based on appointments records • An assessment of continuity of care based on patients’ records • Random phone calls to practices to assess ability to make an appointment by telephone • A questionnaire survey of patients attending the practices • A postal survey of patients who had not attended the surgery in the previous 12 months • A discrete choice experiment to explore trade-offs patients make between access and other factors • A survey of practice staff • Qualitative case studies in 8 practices • Interviews with PCT access facilitators The methods and results for each of these studies are described below, in relation to each of the research objectives.<br/

Determination of the mass of the neutron star in SMC X-1, LMC X-4 and Cen X-3 with VLT/UVES

We present the results of a spectroscopic monitoring campaign of the OB-star companions to the eclipsing X-ray pulsars SMC X-1, LMC X-4 and Cen X-3. High-resolution optical spectra obtained with UVES on the ESO Very Large Telescope are used to determine the radial-velocity orbit of the OB (super)giants with high precision. The excellent quality of the spectra provides the opportunity to measure the radial-velocity curve based on individual lines, and to study the effect of possible distortions of the line profiles due to e.g. X-ray heating on the derived radial-velocity amplitude. Several spectral lines show intrinsic variations with orbital phase. The magnitude of these variations depends on line strength, and thus provides a criterion to select lines that do not suffer from distortions. The undistorted lines show a larger radial-velocity amplitude than the distorted lines, consistent with model predictions. Application of our line-selection criteria results in a mean radial-velocity amplitude K(Opt) of 20.2 +/- 1.1, 35.1 +/- 1.5, and 27.5 +/- 2.3 km/s (1 sigma errors), for the OB companion to SMC X-1, LMC X-4 and Cen X-3, respectively. Adding information on the projected rotational velocity of the OB companion (derived from our spectra), the duration of X-ray eclipse and orbital parameters of the X-ray pulsar (obtained from literature), we arrive at a neutron star mass of 1.06^{+0.11}_{-0.10}, 1.25^{+0.11}_{-0.10} and 1.34^{+0.16}_{-0.14} M{sun} for SMC X-1, LMC X-4 and Cen X-3, respectively. The mass of SMC X-1 is near the minimum mass (~1 M{sun}) expected for a neutron star produced in a supernova. We discuss the implications of the measured mass distribution on the neutron-star formation mechanism, in relation to the evolutionary history of the massive binaries.Comment: Accepted for publication in Astronomy and Astrophysic

Effective interaction dependence of the liquid-gas phase transition in symmetric nuclear matter

The liquid-gas phase transition for homogeneous symmetric nuclear matter is studied in the mean-field approximation. Critical properties are computed using a comprehensive group of Skyrme and Gogny forces in an effort to elucidate the effective interaction dependence of the results. Analytical models for the thermodynamical and critical properties are discussed and compared to an extensive set of mean-field data. In agreement with these models, a tight correlation is found between the flashing and the critical points. Accurate predictions for the critical temperature, based on saturation properties, can only be obtained after the density dependence of the effective mass is properly taken into account. While the thermodynamical properties coming from different mean-fields do not follow a law of corresponding states, the critical exponents for all the mean-fields have been found to be the same. Their values coincide with those predicted by the Landau mean-field theory of critical phenomena.Comment: 43 pages, 10 figures, 2 tables; added figure and references; revised manuscript for publicatio

The Evolution of Compact Binary Star Systems

We review the formation and evolution of compact binary stars consisting of white dwarfs (WDs), neutron stars (NSs), and black holes (BHs). Binary NSs and BHs are thought to be the primary astrophysical sources of gravitational waves (GWs) within the frequency band of ground-based detectors, while compact binaries of WDs are important sources of GWs at lower frequencies to be covered by space interferometers (LISA). Major uncertainties in the current understanding of properties of NSs and BHs most relevant to the GW studies are discussed, including the treatment of the natal kicks which compact stellar remnants acquire during the core collapse of massive stars and the common envelope phase of binary evolution. We discuss the coalescence rates of binary NSs and BHs and prospects for their detections, the formation and evolution of binary WDs and their observational manifestations. Special attention is given to AM CVn-stars -- compact binaries in which the Roche lobe is filled by another WD or a low-mass partially degenerate helium-star, as these stars are thought to be the best LISA verification binary GW sources.Comment: 105 pages, 18 figure

General practitioners' perceptions of the appropriateness and inappropriateness of our of hours calls

Background: The number of out-of-hours calls to general practitioners (GPs) has increased steadily during the past 20 years. The proportion of inappropriate calls are reportedly increasing but we know very little about how GPs judge a call to be appropriate or inappropriate. Aim: To determine the factors that influence GPs' perceptions of the appropriateness or inappropriateness of out-of-hours calls. Design of Study: Postal questionnaire survey. Setting: GP members of the Wessex Primary Care Research Network (WReN) and the Northern Primary Care Research Network (NoReN). Method: General Practitioners were asked to write down what they meant by an 'appropriate' and 'inappropriate' out-of-hours call. The free text was subjected to content analysis. Results: Detailed responses were received from 146 (73%) GPs. General practitioners appear to have a well developed classification of the appropriateness of out-of-hours calls. Factors that make calls appropriate include not only the nature of patients' symptoms and illness but also non-medical factors such as patients' compliance and politeness. Conclusion: The inclusion by GPs of non-medical factors in their conceptualisation of the appropriateness of out-of-hours calls may contribute to patients' confusion about what is and is not appropriate and also to the apparent failure of patient education initiatives designed to decrease inappropriate demand

Physiotherapy extended scope of practice: who is doing what and why?

Objectives To explore the range, drivers and perspectives of extended or enhanced practitioner roles within physiotherapy. Data sources Nineteen electronic databases, hand searches, bibliography scanning and personal contact were used to identify published and unpublished resources. Review methods A systematic review using an expanded approach. Resources were included if they discussed extended scope of practice (intervention) in physiotherapy (profession) and outcome (for patients, other health professionals, and health services delivery) irrespective of patient group, language, year of publication (up to 2005), study design, or health care systems evaluated. All resources were screened against formal inclusion criteria for relevance. Information from relevant resources was extracted and details were entered into an Access database. Results One hundred and fifty-two physiotherapy-related resources were identified, including seven which met appropriate quality standards (using Cochrane methodology). A meta-analysis was not performed due to the paucity of randomised controlled trials. Conclusions Drivers for the roles in the 152 resources mainly included local or national service demands (34%). Most extended scope of practice roles reported included a form of non-invasive assessment (47%) or non-invasive treatment (37%) of patients that was more traditionally carried out by medical colleagues. None of the resources including data was (a) unsupportive of extended scope of practice or (b) mainly expressing concerns. This review has demonstrated overwhelming support for extended scope of practice; the vast majority of resources were supportive despite being largely descriptive or discursive in nature (76%). There is an urgent need for robust research in order to evaluate the expansion of extended scope of practice roles, underpin further development of those roles, and strengthen the evidence base of extended scope of practice in physiotherapy