ORCID Profile
0000-0003-3234-8987
Current Organisation
King's College London
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Publisher: Royal College of General Practitioners
Date: 25-09-2017
Abstract: In international studies, greater investment in primary health care is associated with improved population health outcomes. To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. Retrospective cross-sectional study of general practices in England, 2014–2015. Practice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding. Mean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements ( n = 2784), £78.79 in GMS practices without capitation supplements ( n = 1672), and £84.43 in PMS practices ( n = 3022). The mean capitation supplement was £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type. Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs.
Publisher: Oxford University Press (OUP)
Date: 12-2016
DOI: 10.5665/SLEEP.6316
Publisher: Oxford University Press (OUP)
Date: 05-2016
DOI: 10.5665/SLEEP.5740
Publisher: American Psychological Association (APA)
Date: 2014
DOI: 10.1037/NEU0000065
Abstract: To assess cognition in populations born and living at high altitude (HA 3,700 m) and low altitude (LA 500 m) in Bolivia, who were similar for both socioeconomic status and genetic ancestry. To determine whether HA hypoxia influences cognitive decline across the life span. In total, 191 healthy participants aged 4 to 85 years were assessed at HA (N = 94 33 35% male) and LA (N = 97 46, 47% male) on a battery of cognitive tasks: fluid intelligence, attention, short- and long-term memory, and psychomotor speed. Saliva s les were obtained for evaluation of genetic ancestry. HA participants were significantly slower on measures of processing speed and speed of attention than in iduals born and living at LA. HA participants had slightly higher percentage of native Andean ancestry than LA participants, but this was not associated with cognitive performance. This is the first study of HA residence and neurocognition across the life span. Given the physiological challenges of HA living, the impact on cognition appears to be subtle and related only to the speed of more complex cognitive operations, rather than to their accuracy. Moreover, the impact on cognition does not appear to differ with increasing age or for different degrees of genetic admixture. Further studies recruiting HA participants with a broader range of native Andean ancestry will help to address the issue of to what extent Amerindian ancestry provides neuroprotection to chronic hypoxia in those living at HA.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Veline L'Esperance.