Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

Modeling gross primary production of alpine ecosystems in the Tibetan Plateau using MODIS images and climate data

The eddy covariance technique provides measurements of net ecosystem exchange (NEE) Of CO2 between the atmosphere and terrestrial ecosystems, which is widely used to estimate ecosystem respiration and gross primary production (GPP) at a number Of CO2 eddy flux tower sites. In this paper, canopy-level maximum light use efficiency, a key parameter in the satellite-based Vegetation Photosynthesis Model (VPM), was estimated by using the observed CO2 flux data and photosynthetically active radiation (PAR) data from eddy flux tower sites in an alpine swamp ecosystem, an alpine shrub ecosystem and an alpine meadow ecosystem in Qinghai-Tibetan Plateau, China. The VPM model uses two improved vegetation indices (Enhanced Vegetation Index (EVI), Land Surface Water Index (LSWI)) derived from the Moderate Resolution Imaging Spectral radiometer (MODIS) data and climate data at the flux tower sites, and estimated the seasonal dynamics of GPP of the three alpine grassland ecosystems in Qinghai-Tibetan Plateau. The seasonal dynamics of GPP predicted by the VPM model agreed well with estimated GPP from eddy flux towers. These results demonstrated the potential of the satellite-driven VPM model for scaling-up GPP of alpine grassland ecosystems, a key component for the study of the carbon cycle at regional and global scales. (c) 2006 Elsevier Inc. All rights reserved.

Comparison of new and primary production models using SeaWiFS data in contrasting hydrographic zones of the northern North Atlantic.

The accuracy of two satellite models of marine primary (PP) and new production (NP) were assessed against 14C and 15N uptake measurements taken during six research cruises in the northern North Atlantic. The wavelength resolving model (WRM) was more accurate than the Vertical General Production Model (VGPM) for computation of both PP and NP. Mean monthly satellite maps of PP and NP for both models were generated from 1997 to 2010 using SeaWiFS data for the Irminger basin and North Atlantic. Intra- and inter-annual variability of the two models was compared in six hydrographic zones. Both models exhibited similar spatio-temporal patterns: PP and NP increased from April to June and decreased by August. Higher values were associated with the East Greenland Current (EGC), Iceland Basin (ICB) and the Reykjanes Ridge (RKR) and lower values occurred in the Central Irminger Current (CIC), North Irminger Current (NIC) and Southern Irminger Current (SIC). The annual PP and NP over the SeaWiFS record was 258 and 82 gC m-2 yr-1 respectively for the VGPM and 190 and 41 gC m-2 yr-1 for the WRM. Average annual cumulative sum in the anomalies of NP for the VGPM were positively correlated with the North Atlantic Oscillation (NAO) in the EGC, CIC and SIC and negatively correlated with the multivariate ENSO index (MEI) in the ICB. By contrast, cumulative sum of the anomalies of NP for the WRM were significantly correlated with NAO only in the EGC and CIC. NP from both VGPM and WRM exhibited significant negative correlations with Arctic Oscillation (AO) in all hydrographic zones. The differences in estimates of PP and NP in these hydrographic zones arise principally from the parameterisation of the euphotic depth and the SST dependence of photo-physiological term in the VGPM, which has a greater sensitivity to variations in temperature than the WRM. In waters of 0 to 5C PP using the VGPM was 43% higher than WRM, from 5 to 10C the VGPM was 29% higher and from 10 to 15C the VGPM was 27% higher.

Review of the Viability Audit process: analysis of post-primary school data

This paper provides an analysis of the post-primary school data provided in the viability audit report published in February 2012 and complements a paper already prepared with an analysis of primary school data. The Viability Audit has been led by the Education and Library Boards, working in close conjunction with CCMS. The Area Planning process was led by the Department of Education, working with the Education and Library Boards and CCMS.

Review of the Viability Audit process: analysis of primary school data

This paper provides an analysis of the primary school data provided in the viability audit report published in February 2012. The Viability Audit has been led by the Education and Library Boards, working in close conjunction with CCMS. The Area Planning process was led by the Department of Education, working with the Education and Library Boards and CCMS. Draft area planning reports, and revised reports following consultation, have been published for post primary schools; draft area planning reports for primary schools have been published and are not out for consultation. It should be noted that the draft area plan reports for primary schools used updated data available to the ELBs so some of the patterns will differ slightly from those reported in the analysis below.

The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study

Background English National Quality Requirements mandate out-of-hours primary care services to routinely audit patient experience, but do not state how it should be done.

Objectives We explored how providers collect patient feedback data and use it to inform service provision. We also explored staff views on the utility of out-of-hours questions from the English General Practice Patient Survey (GPPS).

Methods A qualitative study was conducted with 31 staff (comprising service managers, general practitioners and administrators) from 11 out-of-hours primary care providers in England, UK. Staff responsible for patient experience audits within their service were sampled and data collected via face-to-face semistructured interviews.

Results Although most providers regularly audited their patients’ experiences by using patient surveys, many participants expressed a strong preference for additional qualitative feedback. Staff provided examples of small changes to service delivery resulting from patient feedback, but service-wide changes were not instigated. Perceptions that patients lacked sufficient understanding of the urgent care system in which out-of-hours primary care services operate were common and a barrier to using feedback to enable change. Participants recognised the value of using patient experience feedback to benchmark services, but perceived weaknesses in the out-of-hours items from the GPPS led them to question the validity of using these data for benchmarking in its current form.

Conclusions The lack of clarity around how out-of-hours providers should audit patient experience hinders the utility of the National Quality Requirements. Although surveys were common, patient feedback data had only a limited role in service change. Data derived from the GPPS may be used to benchmark service providers, but refinement of the out-of-hours items is needed.

GeoHealth: A Georeferenced System for Health Data Analysis in Primary Care

The Primary Care Information System (SIAB) concentrates basic healthcare information from all different regions of Brazil. The information is collected by primary care teams on a paper-based procedure that degrades the quality of information provided to the healthcare authorities and slows down the process of decision making. To overcome these problems we propose a new data gathering application that uses a mobile device connected to a 3G network and a GPS to be used by the primary care teams for collecting the families' data. A prototype was developed in which a digital version of one SIAB form is made available at the mobile device. The prototype was tested in a basic healthcare unit located in a suburb of Sao Paulo. The results obtained so far have shown that the proposed process is a better alternative for data collecting at primary care, both in terms of data quality and lower deployment time to health care authorities.