Martin Roland
Dados Biográficos
| ID | 250533 |
|---|---|
| NOME | Martin Roland |
| PRENOMES | Martin |
| SOBRENOME | Roland |
| ASSINATURA | ROLAND M |
| AFILIAÇÕES | University of Cambridge |
| ORCID | 0000-0002-8533-3060 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 43 |
| TOTAL DE CITAÇÕES | 248 |
| TOTAL COMO AUTOR | 43 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1910 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2025 |
| ÍNDICE H | 8 |
Three-Year Follow-Up of a Hybrid Adapted Physical Activity Program Including Telehealth in Comparison to In-Person Care for Chronic Conditions
Adapted physical activity (PA) programs benefit patients with non‐communicable diseases, but access barriers limit reach. Hybrid programs mixing in‐person and telehealth sessions may overcome these constraints. The purpose of this study was to evaluate the acceptability and effectiveness of a 3‐month hybrid APA program compared with usual face‐to‐face care and to examine whether benefits persist up to 36 months. Twenty patients with chronic disea…
Hauora Māori – Māori health
Māori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Mā…
Nurses’ work in relation to patient health outcomes
Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients
Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study
Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care
The Lancet Global Health Commission on financing primary health care
The COVID-19 pandemic has brought the need for well-functioning primary health care (PHC) into sharp focus. PHC is the best platform for providing basic health interventions (including effective management of non-communicable diseases) and essential public health functions. PHC is widely recognised as a key component of all high-performing health systems and is an essential foundation of universal health coverage. PHC was famously set as a global…
Integrated Care in England – what can we Learn from a Decade of National Pilot Programmes
Pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions
Years on. Has the vision of Alma-Ata been realized
In this issue of Cadernos de Sade Pblica, four articles describe the state of primary care in Portugal 1 , Brazil 2 , Canada 3 and Chile 4 . These papers are timely in view of the 40th anniversary of the 1978 Alma-Ata Declaration 5 . This landmark declaration in the history of primary care asserted that "All governments should formulate national policies, to launch and sustain primary health care as part of a comprehensive national health system"…
Patients’ use and views of real‐time feedback technology in general practice
BACKGROUND: There is growing interest in real-time feedback (RTF), which involves collecting and summarizing information about patient experience at the point of care with the aim of informing service improvement. OBJECTIVE: To investigate the feasibility and acceptability of RTF in UK general practice. DESIGN: Exploratory randomized trial. SETTING/PARTICIPANTS: Ten general practices in south-west England and Cambridgeshire. All patients attendin…
Doctors’ engagements with patient experience surveys in primary and secondary care
BACKGROUND: Patient experience surveys are increasingly important in the measurement of, and attempts to improve, health-care quality. To date, little research has focused upon doctors' attitudes to surveys which give them personalized feedback. AIM: This paper explores doctors' perceptions of patient experience surveys in primary and secondary care settings in order to deepen understandings of how doctors view the plausibility of such surveys. D…
Wasting the doctor's time? A video-elicitation interview study with patients in primary care
Awareness of cervical cancer risk factors and symptoms
BACKGROUND: Lack of awareness of risk factors and symptoms for cancer may lead to late diagnosis and poor prognosis. OBJECTIVE: We assessed community awareness about cervical cancer risk factors and symptoms and perceptions about prevention and cure of cervical cancer in order to contribute data to inform interventions to improve cervical cancer survival. DESIGN: Cross-sectional population-based survey. SETTING AND PARTICIPANTS: We conducted this…
The role of patient experience surveys in quality assurance and improvement
BACKGROUND: Despite widespread adoption of patient feedback surveys in international health-care systems, including the English NHS, evidence of a demonstrable impact of surveys on service improvement is sparse. OBJECTIVE: To explore the views of primary care practice staff regarding the utility of patient experience surveys. DESIGN: Qualitative focus groups. SETTING AND PARTICIPANTS: Staff from 14 English general practices. RESULTS: Whilst parti…
Drivers of overall satisfaction with primary care
BACKGROUND/OBJECTIVES: To determine which aspects of primary care matter most to patients, we aim to identify those aspects of patient experience that show the strongest relationship with overall satisfaction and examine the extent to which these relationships vary by socio-demographic and health characteristics. DESIGN/SETTING: Data from the 2009/10 English General Practice Patient Survey including 2,169,718 respondents registered with 8362 prim…
Not living with both parents is associated with more health- and developmental problems in infants aged 7 to 11 months
This study confirms the possibility that not living with both parents is an independent risk factor for the somatic health and psychomotor development of infants. This observation should be verified because it would have a major impact on the actions of family doctors and other first-line healthcare providers, in particular with regard to information and targeted prevention
Evaluating Differential Item Functioning in the English General Practice Patient Survey
All communication items in the English GP Patient Survey showed similar South Asian versus white British differences, with no evidence of DIF. In contrast, differences due to scale use or expectations are typically variable rather than constant across scales. While other possibilities remain, these findings increase the likelihood that the observed negative responses of South Asian patients to this national survey reflect true differences in thei…
Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life
Patients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services
Public acceptability of government intervention to change health-related behaviours
Barriers and facilitators to integrating care
Many barriers and facilitators to integrating care are those of any large-scale organisational change. These include issues relating to leadership, organisational culture, information technology, physician involvement, and availability of resources. However, activities which appear particularly important for delivering integrated care include personal relationships between leaders in different organisations, the scale of planned activities, gover…
Case management for at-risk elderly patients in the English integrated care pilots
Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve patient experience, case management approaches need to be introduced in a way which respects patients' wishes, for example the ability to see a familiar doctor or nurse
Continuity of care
Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to ge…
Influences of organizational features of healthcare settings on clinical decision making
A proliferating literature documents cross-national variation in medical practice and seeks to explain observed differences in terms of the presence of certain kinds of healthcare systems, economic, and cultural differences between countries. Less is known about how providers themselves understand these influences and perceive them as relevant to their clinical work. Using qualitative data from a cross-national factorial experiment in the United …
Judging nudging
Nudging has captured the imagination of the public, researchers, and policy makers as a way of changing human behaviour, with both the UK and US governments embracing it. Theresa Marteau and colleagues ask whether the concept stands up to scientific scrutiny
How can Health Care Organizations be Reliably Compared
BACKGROUND: Patient experience is increasingly used to assess organizational performance, for example in public reporting or pay-for-performance schemes. Conventional approaches using 95% confidence intervals are commonly used to determine required survey samples or to report performance but these may result in unreliable organizational comparisons. METHODS: We analyzed data from 2.2 million patients who responded to the English 2009 General Prac…
Evaluation of UK Integrated Care Pilots
This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare
Differences in the Diagnosis and Management of Type 2 Diabetes in 3 Countries (US, UK, and Germany)
OBJECTIVES: This article examines the diagnosis and management of type-2 diabetes when exactly the same "patient" is encountered by 192 randomly selected primary care doctors in 3 different health care systems--the United States, United Kingdom, and Germany. METHODS: We conducted a factorial experiment, employing 2 clinically authentic filmed scenarios, to examine country differences in the treatment of diabetes, while controlling the effects of …
Defining quality of care
Framing the doctor-patient relationship in chronic illness
How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re-analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in re…
Governing the ethical consumer
Government policy promoting consumerism in healthcare can be seen as offering up certain preferred identities to which its citizens are encouraged to aspire. Whilst many commentators reject the notion that health services users should be conceived of as consumers, this paper outlines the relevance of the concept to our understanding of the ways in which individuals manage their health and service use. The paper examines the identity work undertak…
A subtle governance
In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisatio…
Barriers and facilitators to integrating care
Many barriers and facilitators to integrating care are those of any large-scale organisational change. These include issues relating to leadership, organisational culture, information technology, physician involvement, and availability of resources. However, activities which appear particularly important for delivering integrated care include personal relationships between leaders in different organisations, the scale of planned activities, gover…
How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment
Wasting the doctor's time? A video-elicitation interview study with patients in primary care
Governmentality by Network in English Primary Healthcare
In England, the quality of clinical work is being regulated in new ways following recent developments in “clinical governance” policy and apparent failures in the previous system of medical self‐regulation. Using multiple case studies, this paper examines how these changes are affecting professional governmentality and discipline in general practice. Formal organizational structures play little role in clinical governance there. Clinical quality …
Case management for at-risk elderly patients in the English integrated care pilots
Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve patient experience, case management approaches need to be introduced in a way which respects patients' wishes, for example the ability to see a familiar doctor or nurse
Influences of organizational features of healthcare settings on clinical decision making
A proliferating literature documents cross-national variation in medical practice and seeks to explain observed differences in terms of the presence of certain kinds of healthcare systems, economic, and cultural differences between countries. Less is known about how providers themselves understand these influences and perceive them as relevant to their clinical work. Using qualitative data from a cross-national factorial experiment in the United …
Evaluation of UK Integrated Care Pilots
This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare
Users' understanding of medical knowledge in general practice
Years on. Has the vision of Alma-Ata been realized
In this issue of Cadernos de Sade Pblica, four articles describe the state of primary care in Portugal 1 , Brazil 2 , Canada 3 and Chile 4 . These papers are timely in view of the 40th anniversary of the 1978 Alma-Ata Declaration 5 . This landmark declaration in the history of primary care asserted that "All governments should formulate national policies, to launch and sustain primary health care as part of a comprehensive national health system"…
Getting research into practice
Computing in general practice Computing in general practice can scarcely be considered news. More than 20 years ago information was being collected and entered onto what were then called "main- frame" computers, in Britain and elsewhere. The explosion into desktop computers produced a rapid expansion of what (at least in the early days) some people would consider "data" about GP activity as opposed to useful "in- formation" about clinical practic…
Les Grottes néolithiques de Villevenard (Marne)
Roland Augustin. Les Grottes néolithiques de Villevenard (Marne). In: Bulletin de la Société préhistorique de France, tome 7, n°10, 1910. pp. 521-525
Pay more, get more? The influence of pay on doctors' behaviour
Comment Pay more, get more? The influence of pay on doctors' behaviour Does the way in which doctors are paid for their work influence what they do? The article by Kristiansen and Holtedahl on page 481 suggests that it does. Norwegian doctors who were remunerated under a system that gave them 31 for home visits were more likely to do routine home visits than doctors who were paid 6 for such a visit. This is perhaps not surprising, and indeed it i…
Getting research into practice
Computing in general practice Computing in general practice can scarcely be considered news. More than 20 years ago information was being collected and entered onto what were then called "main- frame" computers, in Britain and elsewhere. The explosion into desktop computers produced a rapid expansion of what (at least in the early days) some people would consider "data" about GP activity as opposed to useful "in- formation" about clinical practic…
Is follow up by specialists routinely needed after elective surgery? A controlled trial
STUDY OBJECTIVE: To assess the benefit of planned specialist follow up appointments after elective inpatient surgery. DESIGN: This was a controlled trial, using repeated alternate allocation of time periods to the two study groups. Group 1: Planned outpatient follow up 6-12 weeks after surgery. Group 2: No planned follow up: additional written information for patients and general practitioners. SETTING: A district general hospital in the north we…
The Effect of Panel Membership and Feedback on Ratings in a Two-Round Delphi Survey
BACKGROUND: Past observational studies of the RAND/UCLA Appropriateness Method have shown that the composition of panels affects the ratings that are obtained. Panels of mixed physicians make different judgments from panels of single specialty physicians, and physicians who use a procedure are more likely to rate it more highly than those who do not. OBJECTIVES: To determine the effect of using physicians and health care managers within a panel d…
Walking in an environment of moving ground texture
The visual control of global body movements has mainly been studied in terms of the maintenance of balance. The present experiment examined the effect of moving visual surroundings on the speed of locomotion. A virtually boundless optical environment was generated by the projection of a dotted texture on the ground that was reflected on large vertical mirrors fixed along the walls of the room. Subjects' head velocity was recorded over a walking p…
Defining quality of care
Citizens’ expectations and likely use of a NHS Walk‐in Centre
Objectives To find out which groups of people would use a National Health Service walk‐in centre that would offer mainly health care advice, staffed by nurses. To understand the circumstances in which people would use a walk‐in centre and to ascertain to what extent it would meet patients’ expressed health‐care needs. Design A postal survey of 2400 people plus 27 semi‐structured interviews and one focus group. Setting and participants The study w…
User involvement in clinical governance
Objectives To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as muc…
Users' understanding of medical knowledge in general practice
A subtle governance
In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisatio…
Governmentality by Network in English Primary Healthcare
In England, the quality of clinical work is being regulated in new ways following recent developments in “clinical governance” policy and apparent failures in the previous system of medical self‐regulation. Using multiple case studies, this paper examines how these changes are affecting professional governmentality and discipline in general practice. Formal organizational structures play little role in clinical governance there. Clinical quality …
Framing the doctor-patient relationship in chronic illness
How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re-analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in re…
What are the key attributes of primary care for patients? Building a conceptual ‘map’ of patient preferences
Background Responding to the preferences of patients is a key focus of current health policy and is especially important in primary care. Responding effectively to patient preferences requires a clear understanding of the way in which patients assess primary care services. Objective This study was designed to provide a ‘map’ of the content and structure of the key attributes of patient preferences concerning primary care. Design The development o…
Combining Multiple Indicators of Clinical Quality
OBJECTIVE: To compare different methods of combining quality indicators scores to produce composite scores that summarize the overall performance of health care providers. METHODS: Five methods for computing a composite quality score were compared: the "All-or-None," the "70% Standard," the "Overall Percentage," the "Indicator Average," and the "Patient Average." The first 2 "criterion-referenced" methods assess the degree to which a provider has…
Governing the ethical consumer
Government policy promoting consumerism in healthcare can be seen as offering up certain preferred identities to which its citizens are encouraged to aspire. Whilst many commentators reject the notion that health services users should be conceived of as consumers, this paper outlines the relevance of the concept to our understanding of the ways in which individuals manage their health and service use. The paper examines the identity work undertak…
How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment
Defining Comorbidity
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. In this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies i…
Evaluation of UK Integrated Care Pilots
This evaluation will produce a portfolio of evidence aimed at strengthening the evidence base for integrated care, and in particular identifying the context in which interventions are likely to be effective. These data will support a series of evaluation judgements aimed at reducing uncertainties about the role of integrated care in improving the efficient and effective delivery of healthcare
Differences in the Diagnosis and Management of Type 2 Diabetes in 3 Countries (US, UK, and Germany)
OBJECTIVES: This article examines the diagnosis and management of type-2 diabetes when exactly the same "patient" is encountered by 192 randomly selected primary care doctors in 3 different health care systems--the United States, United Kingdom, and Germany. METHODS: We conducted a factorial experiment, employing 2 clinically authentic filmed scenarios, to examine country differences in the treatment of diabetes, while controlling the effects of …
Judging nudging
Nudging has captured the imagination of the public, researchers, and policy makers as a way of changing human behaviour, with both the UK and US governments embracing it. Theresa Marteau and colleagues ask whether the concept stands up to scientific scrutiny
How can Health Care Organizations be Reliably Compared
BACKGROUND: Patient experience is increasingly used to assess organizational performance, for example in public reporting or pay-for-performance schemes. Conventional approaches using 95% confidence intervals are commonly used to determine required survey samples or to report performance but these may result in unreliable organizational comparisons. METHODS: We analyzed data from 2.2 million patients who responded to the English 2009 General Prac…
Barriers and facilitators to integrating care
Many barriers and facilitators to integrating care are those of any large-scale organisational change. These include issues relating to leadership, organisational culture, information technology, physician involvement, and availability of resources. However, activities which appear particularly important for delivering integrated care include personal relationships between leaders in different organisations, the scale of planned activities, gover…
Case management for at-risk elderly patients in the English integrated care pilots
Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve patient experience, case management approaches need to be introduced in a way which respects patients' wishes, for example the ability to see a familiar doctor or nurse
Continuity of care
Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to ge…
Medicine (35 obras) · Primary Care and Health Outcomes (27 obras) · Health care (23 obras) · Psychology (21 obras) · Nursing (20 obras) · Family medicine (16 obras) · Political science (14 obras) · Patient Satisfaction in Healthcare (10 obras) · Patient-Provider Communication in Healthcare (10 obras) · Healthcare Policy and Management (9 obras)