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Objectives: The aim of this study was to estimate the time and travel costs generated by women when attending for Papanicolaou (Pap) smear tests or colposcopy appointments in the United Kingdom, both absolutely and relative to the health service cost of the national cervical cancer screening programs.
Methods: Data were obtained from questionnaires completed by two samples of women participating in a three-center trial of management of low-grade abnormalities detected by screening (n = 1,106 for Pap smears and n = 1,203 for colposcopy appointments). Women were 20 to 59 years of age and resident in Grampian or Tayside, Scotland, or Nottingham, England. Questionnaire data were supplemented with sociodemographic information previously collected at the time of recruitment to the trial.
Results: The mean total time and travel costs per attendance at a smear test and at a colposcopy appointment were estimated to be £9.2 and £27.4, respectively, averaged across the three trial areas (valued at 2002 prices). Statistically significant intercenter disparities in time and travel costs were identified, particularly with respect to colposcopy appointments. For these, time and travel costs in Nottingham were substantially less than those in Grampian and Tayside (£22.9, £30.2, and £32.1, respectively). Time and travel costs amount to 26 and 33 percent, approximately, over and above the direct health service costs of the English and Scottish screening programs, respectively.
Conclusions: The time and travel costs associated with participation in the UK cervical cancer screening programs are substantial and are not spatially uniform across the country.
In the UK, older people who are resident in care homes because of their needs for social support and personal care receive their health care from primary health care. Although there is increasing input from district nurses in care homes (Audit Commission, 1999), there is little knowledge or recognition of the primary care nursing contribution. This paper reviews two types of research literature: studies that consider the health care needs of older people in residential care homes that could inform nursing support and interventions in care homes, and research that describes the nursing involvement with these settings. The paper argues that on the basis of the research reviewed many of the health problems older people in care homes experience could be avoided or improved by primary care nursing support and intervention. A reassessment is needed of how the interface between community and residential care is managed so that older people in care homes have access to appropriate health care support.
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