Aly Rashid

De Montfort University, Leiscester, England, United Kingdom

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Publications (9)17.81 Total impact

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    ABSTRACT: OBJECTIVES: To explore the reasons for attendance at the emergency department (ED) by patients who could have been managed in an alternative service and the rate of acute admissions to one acute hospital. DESIGN: Interview study. SETTING: One acute hospital (University Hospitals of Leicester) in the East Midlands. PARTICIPANTS: 23 patients and/or their carers. METHODS: A purposive sample of patients attending the ED and the linked urgent care centre was identified and recruited. Patients in the sample were approached by a clinician and a researcher and invited to take part in an interview. Patients of different ethnicities and from different age groups, arriving at the ED via different referral routes (self-referral, emergency ambulance, GP referral, out-of-hours services) and attending at different times of the day and night were included. The interviews were recorded and transcribed with the individuals' permission and analysed using the framework analysis approach. RESULTS: Patients' anxiety or concern about the presenting problem, the range of services available to the ED and the perceived efficacy of these services, patients' perceptions of access to alternative services including general practice and lack of alternative pathways were factors that influenced the decision to use the ED. CONCLUSIONS: Access to general practice, anxiety about the presenting problem, awareness and perceptions of the efficacy of the services available in the ED and lack of alternative pathways are important predictors of attendance rates.
    Emergency Medicine Journal 12/2011; · 1.65 Impact Factor
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    ABSTRACT: To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates. A cross-sectional study. Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England. 145 general practices. Hospital admission data were used to calculate the rate of emergency admissions from 145 practices, for two consecutive years (2006/7 and 2007/8). Practice characteristics (size, distance from principal hospital, quality and outcomes framework performance data, patient reports of access to their practices) and patient characteristics (deprivation, ethnicity, gender and age), were used as predictors in a two-level hierarchical model, developed with data for 2007/8, and evaluated against data for 2006/7. Practice characteristics (shorter distance from hospital, smaller list size) and patient characteristics (higher proportion of older people, white ethnicity, increasing deprivation, female gender) were associated with higher admission rates. There was no association with quality and outcomes framework domains (clinical or organisation), but there was an association between patients reporting being able to see a particular general practitioner (GP) and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined. The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates.
    Emergency Medicine Journal 07/2011; 28(7):558-63. · 1.65 Impact Factor
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    ABSTRACT: Strategies are needed to contain emergency-department attendance. Quality of care in general practice might influence the use of emergency departments, including management of patients with chronic conditions and access to consultations. The aim was to determine whether emergency-department attendance rates are lower for practices with higher quality and outcomes framework performance and lower for practices with better patient reported access. A cross-sectional study. Two English primary-care trusts, Leicester City and Leicestershire County and Rutland, with 145 general practices. Using data on attendances at emergency departments in 2006/2007 and 2007/2008, a practice attendance rate was calculated for each practice. In a hierarchical negative binomial regression model, practice population characteristics (deprivation, proportion of patients aged 65 or over, ethnicity, gender) and practice characteristics (total list size, distance from the emergency department, quality and outcomes framework points, and variables measuring satisfaction with access) were included as potential explanatory variables. In both years, greater deprivation, shorter distance from the central emergency department, lower practice list size, white ethnicity and lower satisfaction with practice telephone access were associated with higher emergency-department attendance rates. Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments.
    BMJ quality & safety 06/2011; 20(11):953-8. · 2.39 Impact Factor
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    ABSTRACT: Despite their growing influence on patient management and outcomes, very little is known about patients' perceptions of clinical guidelines. This is a significant omission, particularly for services advocating patient-centred care and informed decision making. To explore the knowledge and attitudes of women with menstrual disorders towards the use of evidence-based clinical guidelines for their condition. Semi-structured interviews were conducted with women with menstrual disorders. Some women were not aware of the existence of clinical guidelines for their condition. Many were unsure as to their exact nature. The most consistent interpretation of guidelines was as a 'set of rules'. Numerous positive aspects of the use of guidelines were identified, for example, ensuring quality and safety for patients, earlier diagnosis, reducing waiting times and improving continuity of care. Negative views involved seeing guidelines as a tool for rationing and concerns over inflexibility. Patients recognized that implementation of guidelines in general practice can be problematic, especially if resources are not made available. An unmet need for information became apparent in this group of patients. Many women felt that they should have access to guidelines that are being used in their medical care and that guidelines had the potential to act as an information resource for patients. A patient-centred service should endeavour to increase patient awareness of the existence and use of clinical guidelines. A patient version of clinical guidelines may be useful in promoting patients involvement in decision making and may improve outcomes.
    Family Practice 04/2010; 27(2):205-11. · 1.83 Impact Factor
  • European Journal of Obstetrics & Gynecology and Reproductive Biology 01/2010; 148:81-85. · 1.84 Impact Factor
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    ABSTRACT: To compare the value of SF36v2 versus multi-attribute utility score (MAS) for predicting treatment outcome in heavy menstrual bleeding (HMB). Longitudinal observational study, in an outpatient service of a large UK teaching hospital. 193 women took part. Women were asked to complete SF36v2 and a multi-attribute utility score (MAS) for menorrhagia before the first consultation. Patient management was determined through an evidence based guideline and blind to their response to the questionnaire. Treatment outcome at 8 months was examined in relation to the physical (PCS) and mental (MCS) health summary scales of SF36v2 and to MAS. At study entry equal numbers of patients, 179 (93%), returned usable responses for SF36v2 and the multi-attribute scale; 178 (92%) returned both. Baseline SF36v2 scores for role physical, bodily pain, social functioning and mental health were significantly lower (p<0.05) for the group of women who finally required surgery, but the difference in PCS or MCS was not statistically significant. The mean MAS score for those who did not need surgery was 50.7, and for those who needed surgery following failed medical treatment was 35.06. The difference was statistically significant (p<0.001, 95% CI 7.47-23.82). Using logistic regression analysis there was a statistically significant association between baseline MAS but not MCS or PCS and the need for surgery. However, there was considerable overlap between treatment groups. MAS may be a better predictor of management outcome compared to SF36v2 for HMB; but its utility for the individual patient is limited.
    European journal of obstetrics, gynecology, and reproductive biology 10/2009; 148(1):81-5. · 1.97 Impact Factor
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    ABSTRACT: A UK-wide scheme to monitor mortality in general practices has been recommended to improve safety. A monitoring scheme might also have a role in improving quality by informing clinical policies. This study investigated the views of primary care teams on the desirable characteristics of mortality data to help them review and plan their clinical policies. 10 general practices in Leicestershire, UK. Development of a format for presentation of mortality data for primary care teams, presentations of the data to team meetings, and subsequent interviews of 16 general practitioners and nurses to identify issues about the improvement and use of the data for informing clinical policies. The presentation was important in helping teams to understand the data. Comparisons should be between practices with similar patient populations, and information provided on deaths from diseases potentially amenable to prevention through clinical intervention. Practice teams used the data in reflecting on their own clinical care. Presentation of data about mortality in practice populations can enable practices to reflect on their clinical policies. The proposed national scheme for monitoring mortality should provide data in a format that helps teams to improve the quality of care as well as improve patient safety.
    Quality and Safety in Health Care 11/2007; 16(5):359-62. · 2.16 Impact Factor
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    ABSTRACT: To review studies of the use of mortality data in quality and safety improvement in general practice. Narrative review. Search of Medline, Embase and CINAHL for articles reporting mortality monitoring or mortality reviews in general practice. The included articles were reported in English and of any study design, excluding case reports and comment pieces. Studies of palliative care and bereavement, and of primary care programmes in developing countries, were excluded. 229 articles were identified in the searches, 65 were identified as potentially relevant and 53 were included in the review. The studies addressed the impact of primary care provision on mortality rates, methods of monitoring mortality, and the role of audit and death registers in quality and safety improvement. General practitioners were interested in using mortality data but reported difficulties in obtaining complete information. There were no experimental studies of the impact of the use of mortality data, and little evidence of long-term systematic initiatives to use mortality data in quality and safety improvement in general practice. Mortality data are not used systematically in general practice although general practitioners appear interested in the potential of this information in improving quality and safety. Improved systems to provide complete data are needed and experimental studies required to determine the effectiveness of use of the data to improve general practice care.
    Quality and Safety in Health Care 04/2007; 16(2):84-9. · 2.16 Impact Factor
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    ABSTRACT: "Referral" characterises a significant area of interaction between primary and secondary care. Despite advantages, it can be inflexible, and may lead to duplication. To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care. A prospective, non-random comparison of two services: women attending the new (Bridges) pathway compared with those attending a consultant-led one-stop menstrual clinic (OSMC). Patients' views were examined using patient career diaries, health and clinical outcomes, and resource utilisation. Follow-up was for 8 months. A large teaching hospital and general practices within one primary care trust (PCT). Between March 2002 and June 2004, 99 women in the Bridges pathway were compared with 94 women referred to the OSMC by GPs from non-participating PCTs. The patient career diary demonstrated a significant improvement in the Bridges group for patient information, fitting in at the point of arrangements made for the patient to attend hospital (ease of access) (p<0.001), choice of doctor (p = 0.020), waiting time for an appointment (p<0.001), and less "limbo" (patient experience of non-coordination between primary and secondary care) (p<0.001). At 8 months there were no significant differences between the two groups in surgical and medical treatment rates or in the use of GP clinic appointments. Significantly fewer (traditional) hospital outpatient appointments were made in the Bridges group than in the OSMC group (p<0.001). A general practice-led model of integrated care can significantly reduce outpatient attendance while improving patient experience, and maintaining the quality of care.
    Quality and Safety in Health Care 04/2007; 16(2):110-5. · 2.16 Impact Factor