Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.

Breast cancer mortality in neighbouring European countries with different level of breast screening but similar access to treatment: An analysis of WHO mortality database

Objective: To compare trends in breast cancer mortality within three pairs of neighbouring European countries in relation to implementation of screening. Design: Retrospective trend analysis.
Setting: Three country pairs (Northern Ireland (United Kingdom) v Republic of Ireland, the Netherlands v Belgium and Flanders (Belgian region south of the Netherlands), and Sweden v Norway).
Data sources: WHO mortality database on cause of death and data sources on mammography screening, cancer treatment, and risk factors for breast cancer mortality.
Main outcome measures: Changes in breast cancer mortality calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in mortality for all ages began to change.
Results: From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway. The time trend and year of downward inflexion were similar between Northern Ireland and the Republic of Ireland and between the Netherlands and Flanders. In Sweden, mortality rates have steadily decreased since 1972, with no downward inflexion until 2006. Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10-15 years.
Conclusions: The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.

An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

Gaining Access to Data Sources in Statutory Social Work Agencies: The Long and Winding Road

This paper details a researcher's experience of gaining access to three statutory social work agencies in order to conduct a study examining how social workers respond to family support cases and how parents and carers experience the intervention of social workers in these cases. The stages in gaining access are outlined, the gate-keepers involved at each stage are identified and some of the difficulties encountered are highlighted and discussed. The paper concludes that researchers need to give greater priority to access considerations and that social work agencies need to give greater priority to co-operation with researchers.

Influence of access to straw provided in racks on the welfare of sows in large dynamic groups

This experiment investigated the effect of providing access to straw in racks on the welfare of sows in large dynamic groups. Two treatments were applied: (1) access to two racks containing chopped barley straw (offering an average of 0.3 kg straw/sow/day) and (2) control, with no straw racks. Treatments were applied to two separate dynamic groups each containing 35 ( 3) sows. Approximately 9 sows were replaced in each of these groups at 3-week intervals (each replacement constituting a replicate of the study). Peak rack usage was shown between 08:00 and 12:00 h, where on average 6% of sows were observed at each rack. On average over a 24-h period, 27% of sows that were observed at the racks were newly introduced. This percentage was significantly greater in the pre- rather than post-feeding yard (P 0.05). A greater proportion of sows performed sham chewing behaviour in the post- rather than the pre-feeding yard (P 0.05). Overall, providing access to straw in racks led to a reduction in pen-directed exploratory behaviour, and this may reflect the fact that sows were provided with an outlet for exploratory and/or foraging behaviour. However, the fact that sham chewing behaviour was not affected suggests that welfare benefits associated with the straw rack treatment were limited. (C) 2007 Elsevier B.V. All rights reserved.

Influence of access to grass silage on the welfare of sows introduced to a large dynamic group

This experiment investigated the effects of providing access to grass silage on the welfare of sows introduced to a large dynamic group. Two treatments were applied: (1) access to racks containing grass silage (offering an average of 1.9 kg silage/sow/day), and (2) control treatment with no grass silage racks. Treatments 1 and 2 were applied to two separate dynamic groups, each containing 37 (2) sows. Approximately 9 sows were replaced in both groups at 3-week intervals, and each of these replacements constituted a replicate of the study. The study was replicated six times using a total of 108 sows. In a time-based cross-over design, treatments were swapped between the two dynamic groups after three replicates. Highest levels of rack usage were shown between 08:00 and 14:00 h. During peak periods, 9.8% of sows were observed at the racks at a given time. On average, 78.5% of sows observed at the racks were newly-introduced animals. Overall levels of aggression to which newly-introduced sows were exposed on the day of introduction to the group were low, and did not differ significantly between treatments (P > 0.05). In addition, injury levels measured 1-week post-introduction to the group did not differ significantly between treatments (P > 0.05). Sham chewing behaviour was more prevalent in the post-rather than the pre-feeding yard (P

‘Making Older People Equal: Reforming the Law on Access to Education and Other Services’

Age-based discrimination in the supply of goods and services (including educational services) has only very recently been outlawed in the United Kingdom by the Equality Act 2010, the relevant sections of which have not yet been brought into force. This paper critically considers the Act and its implications, as well as the current proposal for an EU Directive on Goods and Services.The greatest immediate potential of the Equality Act lies in the general prohibition against age discrimination and the scope of the exceptions to it. The paper argues that exceptions permitting service providers to discriminate against older people (i.e. negative exceptions) should be very specifically set out in the reforming legislation.There should be no general defence to a claim of age discrimination based around the concept of ‘reasonableness’, which would not be consistently interpreted by courts and tribunals in a way that steers clear of traditional ageist assumptions and stereotyping.The paper argues that service providers should be permitted to discriminate in favour of older people (i.e. make positive exceptions) if the reason for doing do so satisfi es legislative criteria which are designed, amongst other things, to meet the particular needs of older persons or to promote social inclusion. Under this proposal, preferential treatment such as age-related concessionary fees for adult education courses and programmes would be lawful.