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Showing posts from August, 2010

Laparoscopic bariatric surgery in England

A study by Elaine Burns and colleagues published in the BMJ describes the large increase in NHS laparoscopic bariatric surgery operations observed in recent years, with an increase from 238 operations in 2000 to 2543 in 2007. Recent years have also seen large increases in NHS prescribing and spending on drugs for obesity. For example, a study published in the Journal of Public Health Medicine reported that between 1998 and 2005, Orlistat prescriptions in England rose 36-fold from 17,880 to 646,700 and their total cost increased by over 35-fold to £27 million. Sibutramine prescriptions rose from 53,393 in 2001 to around 227,000 in 2005, a 4-fold increase, at a cost of £11 million in 2005.Despite this increased spending on medical and surgical NHS interventions, rates of obesity continue to increase inexorably and around 25% of adults in England are now considered to be obese, with a BMI of 30 or greater.The failure of medical treatments for obesity is further illustrated by the subsequ…

Using information technology to improve patient safety

A recent World Health Organization (WHO) Working Group that I chaired examined the potential of information technology to improve patient safety. The report from the working group was published in the journal Quality & Safety in Healthcare. Previous research has identified as significant issues the substantial variations in the quality and safety of healthcare that patients receive; and the considerable risks of iatrogenic harm to patients. These failings contribute to the high rates of potentially avoidable morbidity and mortality; and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in recent decades and there is now real potential to apply these technological developments to improve the provision of healthcare.

One area of international interest is the use of eHealth applications to address patient safety and quality issues. There is, however, a large gap between the theoretical and em…

Independent sector treatment centres unlikely to be providing value for money

Independent sector treatment centres (ISTCs) were established by the previous government to increase the capacity for elective surgical procedures. The new centres were expensive and there are concerns about the value for money they provide. An article from York University published in the August issue of the Journal of the Royal Society of Medicine concluded that NHS hospitals were treating more complex patients than independent treatment centres. The article provides new information on private sector treatment centres that will help inform the policy of the coalition government. The article highlights the need for much tighter regulation of all units providing NHS services to ensure that they deliver high quality care, provide value for money, and meet minimum standards for data collection.

Other key findings from the article are that private sector treatment centres manage only a very small proportion of NHS-funded elective workload; their clinical coding is much poorer than that o…

Social networking: Not always beneficial for patients

New forms of communication have much to offer, and can help to improve the relationship between doctors and patients, as well as making patients more informed about their health and illness. In my own medical practice, we now offer online access to medical records and patients are starting to use this, particularly for ordering prescriptions and booking appointments. But there can also a downside to new technology, as shown by the recent incident of "bleachgate", which illustrates some of the problems that can arise from the use of these newer methods of communication, such as social networking. In this episode, a 15 year old boy from South Wales, Rhys Morgan, showing remarkable maturity and ability for some one so young, pointed out the problems that could be caused by a putative remedy for Crohn's disease that was being publicised on an online forum for people with Crohn's. Rather than being commended for his actions in exposing a dangerous treatment that could hav…