Dataset Information

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study.

ABSTRACT: OBJECTIVE:To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). DESIGN:Cross-sectional study. SETTING:Regional specialist WMS located in the West of Scotland. PARTICIPANTS:9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. ANALYSIS:Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. RESULTS:Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18-24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30-35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. CONCLUSIONS:There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation.

SUBMITTER: Blane DN

PROVIDER: S-EPMC5719278 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study.

Blane David N DN McLoone Philip P Morrison David D Macdonald Sara S O'Donnell Catherine A CA

BMJ open 20171120 11

<h4>Objective</h4>To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS).<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Regional specialist WMS located in the West of Scotland.<h4>Participants</h4>9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing.<h4>Primary and secondary outcome measures</h4>Primary outcome measure was ...[more]

PMID: 29162575

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Project description:ObjectivesTo compare success of applicants to specialty training posts in the UK by gender, ethnicity and disability status.DesignCross-sectional observational study.SettingNational Health Service, UK.ParticipantsAll specialty training post applications to Health Education England, UK, during the 2021-2022 recruitment cycle.InterventionNil.Primary and secondary outcome measuresComparison of success at application to specialty training posts by gender, ethnicity, country of qualification (UK vs non-UK) and disability. The influence of ethnicity on success was investigated using a logistic regression model, where country of qualification was included as a covariate.Results12 419/37 971 (32.7%) of applicants to specialty training posts were successful, representing 58 specialties. The difference in percentage of successful females (6480/17 523, 37.0%) and males (5625/19 340, 29.1%) was 7.9% (95% CI 6.93% to 8.86%), in favour of females. Segregation of applications to specialties by gender was observed; surgical specialties had the highest proportion of male applicants, while obstetrics and gynaecology had the highest proportion of female applicants. The proportion of successful recruits to specialties largely reflected the number of applications. 11/15 minority ethnic groups (excluding 'not stated') had significantly lower adjusted ORs for success compared with white-British applicants. 'Mixed white and black African' (OR 0.52, 95% CI 0.44 to 0.61, p≤0.001) were the least successful minority group in our study, while non-UK graduates had an adjusted ORs for success of 0.43 (95% CI 0.41 to 0.46, p≤0.001) compared with UK graduates. The difference in percentage of success by disabled applicants (179/464, 38.6%) and non-disabled applicants (11 940/36 418, 32.8%) was 5.79% (95% CI 1.23% to 10.4%), in favour of disabled applicants. No disabled applicants were accepted to 21/58 (36.2%) of specialties.ConclusionsDespite greater success by female applicants overall, there is an attraction issue to specialties by gender. Further, most ethnic minority groups are less successful at application when compared with white-British applicants. This requires continuous monitoring and evaluation of the reasons behind observed differences.Trial registrationNot applicable.

Project description:BackgroundAddressing the causes of low engagement in health care is a prerequisite for reducing health inequalities. People who miss multiple appointments are an under-researched group who might have substantial unmet health needs. Individual-level patterns of missed general practice appointments might thus provide a risk marker for vulnerability and poor health outcomes. We sought to ascertain the contributions of patient and practice factors to the likelihood of missing general practice appointments.MethodsFor this national retrospective cohort analysis, we extracted UK National Health Service general practice data that were routinely collected across Scotland between Sept 5, 2013, and Sept 5, 2016. We calculated the per-patient number of missed appointments from individual appointments and investigated the risk of missing a general practice appointment using a negative binomial model offset by number of appointments made. We then analysed the effect of patient-level factors (including age, sex, and socioeconomic status) and practice-level factors (including appointment availability and geographical location) on the risk of missing appointments.FindingsThe full dataset included information from 909 073 patients, of whom 550 083 were included in the analysis after processing. We observed that 104 461 (19·0%) patients missed more than two appointments in the 3 year study period. After controlling for the number of appointments made, patterns of non-attendance could be differentiated, with patients who were aged 16-30 years (relative risk ratio [RRR] 1·21, 95% CI 1·19-1·23) or older than 90 years (2·20, 2·09-2·29), and of low socioeconomic status (Scottish Index of Multiple Deprivation decile 1: RRR 2·27, 2·22-2·31) significantly more likely to miss multiple appointments. Men missed fewer appointments overall than women, but were somewhat more likely to miss appointments in the adjusted model (1·05, 1·04-1·06). Practice factors also substantially affected attendance patterns, with urban practices in affluent areas that typically have appointment waiting times of 2-3 days the most likely to have patients who serially miss appointments. The combination of both patient and practice factors to predict appointments missed gave a higher pseudo R2 value (0·66) than models using either group of factors separately (patients only R2=0·54; practice only R2=0·63).InterpretationThe findings that both patient and practice characteristics contribute to non-attendance of general practice appointments raise important questions for both the management of patients who miss multiple appointments and the effectiveness of existing strategies that aim to increase attendance. Addressing these issues should lead to improvements in provision of services and public health.FundingScottish Government Chief Scientist Office and Data Sharing and Linkage Service of the Scottish Government.

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Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study.

Publications

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study.

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