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Showing posts from April, 2012

General Practice at a Glance

A new textbook of general practice - General Practice at a Glance - from academics in the Department of Primary Care & Public Health at Imperial College London will be published in October 2012. The authors include Dr Paul Booton, Dr Carol Cooper, Dr Graham Easton & Margaret Harper. The book provides an illustrated introduction to the full range of important primary care presentations. It also includes sample questions to ask during history taking and examination, as well as and featuring ‘red flags’ to highlight symptoms or signs that must not be overlooked. The textbook is ideal for medical students undertaking their general practice attachment and also for other medical practitioners working in primary care.

Smoking Cessation in Taiwan

Evidence that smoking restrictions and raising cigarette taxes affect smokers' behaviour is limited. In a paper published in the Asia-Pacific Journal of Public Health, Tai-Yin Wu and colleagues carried out a study of 200 people in Taipei City, Taiwan to evaluate the association between knowledge of smoking legislation and seeking help in smoking cessation. They compared smokers who sought assistance in clinics/classes and smokers who did not. Both banning smoking and increasing prices had positive effects on smokers' behavior, but the effect size of the latter was larger. Better knowledge of the regulations was associated with greater efforts at smoking cessation. Tai-Yin Wu and colleagues concluded that increased knowledge of smoking regulations is associated with seeking help for smoking.

Identifying patients with neuropathic pain using electronic patient records

Chronic neuropathic pain is challenging to treat and a condition for which further research is needed. Primary care records may allow more appropriate patients to be recruited for clinical studies. In an article by Camille Gajria and colleagues published in the journal Informatics in Primary Care, the authors examined whether electronic primary care records could be used to identify patients with neuropathic pain. The study used data from around 100,000 patients in the London Borough of Brent.  The prevalence of diagnoses associated with chronic neuropathic pain was around 13 per 1000, with the elderly, women and white patients experiencing the greatest burden of disease. The study confirmed that electronic patient records can be used to identify patients with chronic neuropathic pain; and that to make full use of data from these records, standardisation of clinical coding and consensus on diagnostic criteria are needed.

Unintended consequences of quality measurement

Although pay-for-performance programs and public reporting of the performance of health care providers - such as general practices in the UK - have become integral components of strategies to improve the quality of health care, measurement and reporting of the quality of healthcare can also have unintended consequences. In a recent article published in the Annals of Internal Medicine, I discuss 'exception reporting', a method whereby patients who will not benefit from an intervention (such as those who are terminally ill) are excluded from quality measurement and not treated inappropriately.

Exception reporting rates in the UK Quality & Outcomes Framework vary widely among general practices that take part in the scheme. When Dalton et al examined exception reporting rates among people with diabetes from 23 general practices in London, they found that patients who were exception-reported by their physicians were significantly less likely to achieve treatment targets for ha…

Integrated care for diabetes—a Singapore approach

An article in the International Journal of Integrated Care by Su Qian Yeo and colleagues discusses the integrated care approach to managing diabetes in Singapore. The number of individuals with diabetes worldwide has increased from about 153 million in 1980 to about 347 million in 2008, due in part to population growth, ageing, urbanisation, and a rising prevalence of risk factors for type 2 diabetes such as obesity and physical inactivity. This rise in prevalence causes considerable burden on health systems and national economies.This has made developing new models of diabetes care a priority for many health systems.

The Singapore General Hospital (SGH) Delivering on Target (DOT) Programme was launched in 2005 to site clinically stable diabetic patients from the hospital to general practitioners (GPs). The Chronic Disease Management Office (CDMO) was established and a fully customised DOT information technology (IT) system was developed. Three initiatives were implemented: (i) subsi…