No abstract

Objectives To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction.

BACKGROUNDCommunity screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown. METHODSIn a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation. RESULTSWe randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period. CONCLUSIONSAdvice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone.

A structural model of job satisfaction and quitting intentions is estimated using data from a survey of general practitioners in the UK. Previous research has used reduced form models, making the interpretation of coefficients problematic. The use of a structural recursive model helps to clarify the relationships between intentions to quit, overall job satisfaction, domains of job satisfaction and personal and job characteristics. Job and personal characteristics have a direct effect on job satisfaction in addition to their indirect impact through job satisfaction domains. Job satisfaction domains have a direct effect on intentions to quit, in addition to their effect via overall job satisfaction. The structural approach provides a richer interpretation of the role and effect of job characteristics on job satisfaction and intentions to quit than is found in previous research. This is particularly relevant in some public sector labour markets, where the opportunity to alter wages to compensate for the relative advantages and disadvantages of jobs is limited because of national wage bargaining. Copyright Blackwell Publishing Ltd/London School of Economics 2006.

Patient‐reported outcome measures (PROMs) are now routinely collected in the English National Health Service and used to compare and reward hospital performance within a high‐powered pay‐for‐performance scheme. However, PROMs are prone to missing data. For example, hospitals often fail to administer the pre‐operative questionnaire at hospital admission, or patients may refuse to participate or fail to return their post‐operative questionnaire. A key concern with missing PROMs is that the individuals with complete information tend to be an unrepresentative sample of patients within each provider and inferences based on the complete cases will be misleading. This study proposes a strategy for addressing missing data in the English PROM survey using multiple imputation techniques and investigates its impact on assessing provider performance. We find that inferences about relative provider performance are sensitive to the assumptions made about the reasons for the missing data. © 2015 The Authors. Health Economics Published by John Wiley & Sons Ltd.