Objectives: To review and synthesize the existing literature on the experience of living with a diagnosis of hip and/or knee osteoarthritis (OA).
Method: A systematic review was undertaken using ...meta-ethnography. A search of both published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases World Health Organization (WHO) International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, National Institute for Health Research (NIHR) Clinical Research Portfolio Database was undertaken from their inception to 5 June 2013.
Results: Thirty-two studies formed the meta-ethnography of the lived experiences of people with OA. In total, 1643 people with OA were sampled, the majority diagnosed with knee OA. The evidence base was weak to moderate in quality. The majority of studies indicated that people viewed living with OA negatively. Four key factors influenced their attitudes to the condition: the severity of their symptoms; the impact of these symptoms on their functional capability; their attitude towards understanding their disease; and their perceptions of other people's beliefs towards their disease.
Conclusions: The current literature suggests that greater knowledge of the pathology of OA, management of symptoms, promotion of functional activity for patients and their family/friends networks, and understanding to better inform OA patient's role in society are all important elements that affect a person's attitude to OA. By better understanding these factors during future consultations, clinicians may forge stronger relationships with their patients to more effectively manage this long-term disabling condition.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Background Smoking and alcohol consumption has a negative effect on overall health. Limited evidence has been presented as to how these health behaviours may change between pre- and ...postoperative intervals in the initial 12 months post-arthroplasty. The purpose of this study was to address this uncertainty. Hypothesis Smoking and alcohol consumption differs between pre- and post-THA/TKA and it differs between non-arthroplasty cohorts. Materials and methods Data from the Osteoarthritis Initiative (OAI), a population-based observational study in the USA, were gathered. In total, data from 287 people who had undergone THA or TKA from baseline to month 48 OAI follow-up assessments were analysed. Data on this cohort were compared to 287 age- and gender-matched people with osteoarthritis. Mean change from pre- to post-arthroplasty, and differences between arthroplasty and non-arthroplasty participants for smoking and alcohol consumption were assessed descriptively and through Wilcoxin-matched pairs test and Student t -tests (as appropriate). Results The lifetime prevalence of smoking was high for people who received THA (99%) and TKA (96%). Prevalence of current smoking significantly decreased from 5 to 3% across the THA and TKA cohort in the initial 12 months post-arthroplasty ( P < 0.05). Similarly, there was a statistically significant decrease in weekly alcohol consumption post-arthroplasty for people who underwent THA and TKA ( P < 0.01), although the mean difference was only by 0.9 alcoholic drinks. The only statistically significant difference in smoking and alcohol consumption for arthroplasty to non-arthroplasty participants was in weekly alcohol consumption, which was higher by 0.3 drinks in the non-arthroplasty cohort ( P = 0.04). Conclusions Smoking and alcohol consumption decreased in the initial 12 months post-THA and TKA. This was not significantly different to an age- and gender-matched non-arthroplasty cohort. Whilst this is positive, a small group of patients still present with unhealthy lifestyle choices in relation to these behaviours post-arthroplasty. Level of evidence Level III – prospective case control study.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Access to general practices may be an important determinant of emergency admissions for asthma, as early treatment of exacerbations has been shown to prevent deterioration.
To determine whether ...access to primary care is associated with emergency admissions for asthma.
Cross-sectional analysis of data from English practices in 2010-2011.
Negative binomial regression was used to explore the associations between emergency admissions for asthma and seven measures of patient-reported access to general practice services taken from the GP Patient Survey, controlled for the characteristics of practice populations. Incidence rate ratios (IRR) were calculated for each association.
In total 7806 (95%) of practices had data for all variables. There were 3 134 106 patients with asthma, and there were 55 570 emergency admissions with asthma. Admission rates were lower in practices with a higher composite access score (adjusted IRR for 10% change in variable 0.679, 95% CI = 0.665 to 0.708). Admissions were higher in those practices with higher proportions of the practice population who were white, and in practices with lower performance in the Quality and Outcomes Framework indicator 'asthma review in past 15 months' (Asthma 6). Assuming these associations were causal, a higher access score of 10% was associated with a decrease of 17 837 admissions per year for these practices.
Practices with higher patient-reported access had lower rates of emergency admissions for asthma. Policymakers should consider improving access to primary care as one potential way to help prevent emergency hospital admissions for asthma.
BackgroundIn 2003, tackling health inequalities was made a priority for the NHS as part of a cross-governmental strategy, and in 2012 a duty was placed on those commissioning NHS services to consider ...reducing inequality in healthcare access and outcomes. We assess progress between 2004/5 and 2011/12, with the aim of developing the first systematic approach to monitoring socioeconomic inequalities in NHS access and outcomes.MethodsIndicators of healthcare access and outcomes at different stages of the patient pathway were constructed for all English small areas (2001 LSOAs) from 2004/5 to 2011/12 using GMS, QOF, HES and ONS mortality and population data - (1) GP supply: full time equivalent (FTE) GPs per 100,000 population, excluding registrars and retainers, need-weighted using the Carr-Hill workload adjustment, (2) primary care quality: quality and outcomes framework clinical performance, weighted by public health impact, (3) hospital waiting time: days from referral-to-treatment, allowing for patient-level casemix, (4) amenable hospitalisation: unplanned hospitalisation per 100,000 population for conditions amenable to healthcare, indirectly age-sex-standardised, (5) excess hospital stays: proportion of inpatients with excess length of stay, allowing for patient-level casemix, (6) post-hospital mortality: 12-month mortality after discharge, allowing for patient-level casemix and comorbidity, (7) amenable mortality: deaths from causes amenable to health care per 100,000 population, indirectly age-sex-standardised. Slope and relative indices of inequality were calculated through small-area-level regression using all 32,482 Index of Multiple Deprivation 2010 ranks, with regression-based tests of change over time. Equity "dashboards" were developed to communicate findings to decision makers in a concise form.ResultsNationally, all unadjusted relative indices of inequality fell from 2004/5 to 2011/12 (with 95% CIs in brackets, where negative indices represent "pro-poor" inequality): (1) for GP supply from -2.2% -2.9% to -1.6% to -9.5% -10.2% to -8.8%, (2) for primary care quality from 4.1% 3.6% to 4.6% to 1.1% 0.6% to 1.6%, (3) for hospital waiting time from 3.2% 2% to 4.4% to 2.7% 1.5% to 3.8%, (5) for excess hospital stays from 13.8% 14.7% to 12.9% to 8% 9% to 7.1%, (6) for post-hospital mortality from 0.6% 2.3% to -1.2% to -4.5% -2.6% to -6.4%, and (7) for amenable mortality from 34% 36.5% to 31.4% to 11.9% 14.6% to 9.2%.ConclusionSocioeconomic inequality in healthcare access and outcomes in the English NHS reduced between 2004/5 and 2011/12 in both relative and absolute terms on all our indicators (unadjusted), though all indicators except GP supply and post-hospital mortality continued to exhibit "pro-rich" inequality. The main study limitations are imperfect adjustments for need and risk and measurement of socioeconomic status using neighbourhood deprivation.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
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