Objectives-To establish the extent and nature of specialist outreach clinics in primary care Main outcome measures-Number of specialist outreach clinics; organisation and referral mechanism; waiting times; perceived benefits and problems.Result&-28 of the hospitals had a total of 96 outreach clinics, and 32 fundholders identified a further 61 clinics. These clinics covered psychiatry (43), medical specialties (38), and surgical specialties (76). Patients were seen by the consultant in 96% (107) of clinics and general practitioners attended at only six clinics. 61 outreach clinics had shorter waiting times for first outpatient appointment than hospital clinics. The most commonly reported benefits for patients were ease of access and shorter waiting times.Conclusions-Specialist outreach clinics cover a wide range of specialties and are popular, especially in fundholding practices. These clinics do not seem to have increased the interaction between general practitioners and specialists.
An analytical framework of the referral decision was applied to the question of whether general practitioners (GPs) with relatively high and relatively low referral rates differed in the types of factors that influenced their referral decisions. Interview data from six high referring and six low referring GPs were compared at all levels of the framework, using both quantitative and qualitative content analysis. High referrers were found to mention significantly more negative factors than low referrers, i.e. they referred 'in spite of' reasons against referral. In particular, they referred patients in spite of having doubts about treatment effectiveness. Low referrers mentioned factors related to interpersonal processes significantly more often than high referrers, for example, GP-patient communication as an influence. Possible interpretations of these findings are discussed.
Breastfeeding rates for young mothers are lower than for older mothers and are poorer at four months than at initiation. Therefore the aim of this study was to discover which psychosocial factors influence breastfeeding duration and which factors are different between age groups. Fifty-seven participants aged 16–24 and 25–40 completed the following measures antenatally and postnatally: a self-esteem-scale, a parent expectations survey, a general self-efficacy scale (GSES), an attitudes to breastfeeding scale, a breastfeeding support scale and a breastfeeding self-efficacy scale (BSES). Duration of breastfeeding varied from 0 days to 4 months. There was a significant difference in attitudes between the age groups with the older women having more positive attitudes. Multiple hierarchical regression analysis showed that the GSES scores and the BSES scores significantly predicted duration independently of age. Breastfeeding self-efficacy decreased overall after giving birth and to a greater extent in younger mothers who had significantly lower scores on postnatal breastfeeding self-efficacy, which perhaps accounts for younger mothers giving up breastfeeding sooner.
The aims of this study were to explore the meanings attributed to decisions and experiences surrounding breastfeeding and weaning by both parents. The study used semi-structured interviews to elicit the participants' stories. Six women and five men were interviewed in 2004. Transcripts were made of the recorded interviews and these were analysed using the techniques of IPA. Master themes and sub-themes were extracted and it was discovered that the parents were in agreement on many issues. Male and female parents today often work together as a team, but there is a sense among both that the woman should be discreet when breastfeeding. Women therefore need support to be able to feed their infants however, whenever and wherever they wish.
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