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Showing posts from June, 2012

Computer-assisted history-taking systems in health care

Medical history taking lies at the centre of clinical diagnosis and decision-making. Computer-assisted history-taking systems (CAHTS) are tools that aids clinicians in gathering data from patients to inform a diagnosis or treatment plan. Even though CAHTS have been available for nearly three decades, these remain underused in routine clinical practice. In a paper published in the journal Informatics in Primary Care, Yannis Pappas and colleagues reviewed the previous research on CAHTS.

The review reported that CAHTS can save professionals' time, improve delivery of care to those with special needs and also facilitate the collection of information, especially potentially sensitive information (e.g. sexual history, alcohol consumption). The use of CAHTS, however, also has disadvantages that hinder the process of history taking and may pose risks to patients. CAHTS are also limited in detecting non-verbal communication, may pose irrelevant questions and frustrate the users with techn…

Primary Care in Europe: Entering the Age of Austerity

Many European countries have well-developed health systems that offer universal access to health services and which have a strong primary care sector. Primary care physicians are the point of first contact with the health care system in such countries, providing open access to all patients, and dealing with most of the problems patients present with. Strong primary care sectors have allowed health systems in Europe to make efficient use of health care resources, for example, through the gatekeeping role of primary care physicians. However, as the financial crisis in Europe continues to progress, it is now starting to affect health and social services. In Ireland, for example, this has led to a reduction in the number of hospital beds and in recruitment to unfilled posts in the health service. In Italy, additional user charges have been imposed on patients. The potential impact of this new era of financial austerity were discussed in an article I published in the Journal of Ambulatory…

Effect of Pay-for-Performance on Ethnic Disparities in Diabetes Outcomes

The United Kingdom's Quality and Outcomes Framework (QOF) is a pay-for-performance program that rewards family practitioners in the United Kingdom for the achievement of quality standards. The impact of such quality improvement strategies on disparities in health care is unclear. In an article published in the journal Annals of Family Medicine, Riyadh Alshamsan and colleagues carried out an interrupted time series analysis to examine the impact of QOF on ethnic disparities in diabetes outcomes, using data from the electronic medical records diabetes patients registered with 29 family practices in South West London. The main outcome measures examined were mean haemoglobin A1c (HbA1c), total cholesterol, and blood pressure.

They found that the introduction of QOF was associated with initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients . Initial improvements in diastolic blood pressure i…

Hospital admissions for sickle cell disease in England

Sickle cell disease (SCD) is a rising cause of mortality and morbidity in England and consequently an important policy issue for the National Health Service. In an article published recently in the Journal of Public Health, Ghida Aljuburi and colleagues examined SCD admission rates in England using data from the Hospital Episode Statistics database. They reported that the admission rate for SCD per 100 000 people in England has risen from 21.2 in 2001/02 to 33.5 in 2009/10, a rise of over 50%. London accounted for around 75% of all SCD admissions in England. Nearly 60% of patients admitted with SCD were discharged within 24 hours. The authors concluded that because over half of all patients admitted with SCD were discharged within 24 hours, some of these admissions could be prevented through better ambulatory care of patients with sickle cell disease.

In a letter also published in the Journal of Public Health in response to some comments from Radoslav Latinovic and Allison Streetly, …