ORCID Profile
0000-0003-4540-6744
Current Organisation
University of Manchester
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Publisher: Public Library of Science (PLoS)
Date: 26-09-2023
Publisher: Springer Science and Business Media LLC
Date: 28-02-2019
Publisher: Elsevier BV
Date: 11-2010
Publisher: Elsevier BV
Date: 09-2023
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-062942
Abstract: To estimate the strength of association between having an inflexible job and health-related quality of life and healthcare utilisation and to explore heterogeneity in the effects by gender, age and area-level deprivation. Retrospective cross-sectional study. Seven waves of the English General Practice Patient Survey between 2012 and 2017. 1 232 884 people aged 16–64 years and in full-time employment. We measured job inflexibility by inability to take time away from work during usual working hours to seek medical care. Health-related quality of life (EQ-5D-5L) number of months since the respondent last saw a general practitioner (GP) or nurse use of out-of-hours general practice in the past 6 months. We used regression analyses to estimate the strength of association between outcomes and having an inflexible job, adjusting for person and area-level characteristics. One-third of respondents reported job inflexibility. The probability of job inflexibility was higher at younger ages and in more deprived areas. Job inflexibility was associated with lower EQ-5D-5L utility scores of 0.017 (95% CI 0.016 to 0.018) for women and 0.016 (95% CI 0.015 to 0.017) for men. Women were more affected than men in the mental health domain. The reduction in health-related quality of life associated with having an inflexible job was greater for employees who were older or lived in more deprived areas. Having an inflexible job was associated with a longer time since the last visit to their GP of 0.234 (95% CI 0.201 to 0.268) months for women and 0.199 (95% CI 0.152 to 0.183) months for men. Inequalities in the prevalence of inflexible jobs contribute to inequalities in health. One mechanism may be through reduced access to healthcare. Policymakers and employers should ensure that all employees have sufficient job flexibility to protect their health.
Publisher: Wiley
Date: 05-05-2023
DOI: 10.1002/HEC.4695
Abstract: Social participation is defined as an in idual's involvement in activities that provide connections with others in society. Past research has demonstrated links between social participation, improved health and well‐being, and reduced social isolation, but has been restricted to older people and has not investigated heterogeneity. Using cross‐sectional data from the UK's Community Life Survey (2013–2019 N = 50,006), we estimated returns to social participation in the adult population. We included availability of community assets as instruments in a marginal treatment effects model, which allows treatment effects to be heterogeneous and examines whether the effects vary by propensity to participate. Social participation was linked to reduced loneliness and improved health (−0.96 and 0.40 points respectively on 1–5 scales) and increased life satisfaction and happiness (2.17 and 2.03 points respectively on 0–10 scales). These effects were larger for those on low income, with lower education attainment, and who live alone or with no children. We also found negative selection, indicating those less likely to participate have higher health and well‐being returns. Future interventions could focus on increasing community asset infrastructure and encouraging social participation for those with lower socio‐economic status.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JHEALECO.2022.102651
Abstract: Healthcare providers may game when faced with targets. We examine how family doctors responded to a temporary but substantial increase in the stringency of targets determining payments for controlling blood pressure amongst younger hypertensive patients. We apply difference-in-differences and bunching techniques to data from electronic health records of 107,148 in iduals. Doctors did not alter the volume or composition of lists of their hypertension patients. They did increase treatment intensity, including a 1.2 percentage point increase in prescribing antihypertensive medicines. They also undertook more blood pressure measurements. Multiple testing increased by 1.9 percentage points overall and by 8.8 percentage points when first readings failed more stringent target. Exemption of patients from reported performance increased by 0.8 percentage points. Moreover, the proportion of patients recorded as exactly achieving the more stringent target increased by 3.1 percentage points to 16.6%. Family doctors responded as intended and gamed when set more stringent pay-for-performance targets.
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/BMJOPEN-2022-061340
Abstract: The UK social security system is being transformed by the implementation of Universal Credit (UC), which combines six existing benefits and tax credits into a single payment for low-income households. Despite extensive reports of hardship associated with the introduction of UC, no previous studies have comprehensively evaluated its impact on mental health. Because payments are targeted at low-income households, impacts on mental health will have important consequences for health inequalities. We will conduct a mixed methods study. Work package (WP) 1 will compare health outcomes for new recipients of UC with outcomes for legacy benefit recipients in two large population surveys, using the phased rollout of UC as a natural experiment. We will also analyse the relationship between the proportion of UC claimants in small areas and a composite measure of mental health. WP2 will use data collected by Citizen’s Advice to explore the sociodemographic and health characteristics of people who seek advice when claiming UC and identify features of the claim process that prompt advice-seeking. WP3 will conduct longitudinal in-depth interviews with up to 80 UC claimants in England and Scotland to explore reasons for claiming and experiences of the claim process. Up to 30 staff supporting claimants will also be interviewed. WP4 will use a dynamic microsimulation model to simulate the long-term health impacts of different implementation scenarios. WP5 will undertake cost–consequence analysis of the potential costs and outcomes of introducing UC and cost–benefit analyses of mitigating actions. We obtained ethical approval for the primary data gathering from the University of Glasgow, College of Social Sciences Research Ethics Committee, application number 400200244. We will use our networks to actively disseminate findings to UC claimants, the public, practitioners and policy-makers, using a range of methods and formats. The study is registered with the Research Registry: researchregistry6697.
Publisher: BMJ
Date: 02-2017
Publisher: National Institute for Health and Care Research
Date: 08-2018
DOI: 10.3310/HSDR06310
Abstract: The Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness. To explore the process of implementation of the SICP and the impact on patient outcomes and costs. Qualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies. Salford in the north-west of England. Older people aged ≥ 65 years, carers, and health and social care professionals. A large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’). Patient self-management, care experience and quality of life, and health-care utilisation and costs. Professional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation. The SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776). The Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were 40%. The SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes. Further research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use. Current Controlled Trials ISRCTN12286422. This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 6, No. 31. See the NIHR Journals Library website for further project information.
Publisher: Elsevier BV
Date: 12-2020
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-033186
Abstract: Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care. Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation. Participation in community asset facilities. Costs of primary and secondary care. 4377 older people with long-term conditions. Participation in community assets. Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits. Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months £−283 (95% CI £−926 to £359) at 12 months and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months. Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.
Publisher: Springer Science and Business Media LLC
Date: 20-07-2018
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 Luke Munford.