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Showing posts from July, 2013

Use of emergency departments

The use of emergency departments is a prominent policy issue in both England and the USA. In a letter published in JAMA, Thomas Cowling and I compare the use of emergency departments in the two countries. The annual number of hospital ED visits in England increased from 15.4 million in 2007-2008 to 18.4 million in 2011-2012.1 The patient was given advice only or did not receive treatment in approximately 48% of these ED visits, and no investigations were performed in approximately 40% of ED visits.

Patterns of healthcare use among adolescents attending an urban general practitioner-led urgent care centre

Adolescence is a time of increasing health and peak fitness, as well as increasing health risks. In the UK, primary care is free at the point of access, yet, adolescents aged 10-19 years are the lowest users of primary care services, and disproportionately high users of emergency services. The effect of new general practitioner (GP)-led urgent care centres in meeting the needs of adolescents are unknown. In a paper published in the Emergency Medicine Journal, Shamini Gnani and colleagues examined the demographics and attendance pattern among adolescents at two new co-located GP-led urgent care centres at Hammersmith and Charing Cross Hospitals, London. They also compared attendance rates with those observed in routine general practice and emergency departments.

They reported that adolescents formed 6.5% of total urgent care attendances. 13.2% were recorded as not being registered with a GP. Commonest reasons for attendance were musculoskeletal conditions and injuries (30.2%), respira…

Computerised decision support systems for healthcare professionals

Computerised decision support systems are designed to support clinicians in making decisions and thereby enhance the quality and safety of care. In a systematic review published in Informatics in Primary Care, Kathrin Cresswell and her co-authors describe the results of an interpretative review of the empirical evidence on computerised decision support systems, their contexts of use, and summarise evidence on the effectiveness of these tools and insights into how these can be successfully implemented and adopted.

Cresswell and collagues concluded that whilst the potential of clinical decision support systems in improving, in particular, practitioner performance is considerable, such technology may also introduce new risks resulting not only from technical challenges (such as data inaccuracies) but also from disruption of clinical workflows. Moving forward, there is a need for system development, procurement and implementation to be characterised by a user 'pull' and then tail…

One year evaluation of a cardiovascular disease risk assessment program

In a study published in the journal Preventive Medicine, Macide Artac and colleagues assessed whether the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program, was associated with reduction in CVD risk in attendees after one year. They used data on patients aged 40–74 years, with high estimated CVD risk, who were registered with general practices in a deprived, culturally diverse setting in England. They included 4748 patients at baseline (July 2008–November 2009), with 3712 at follow-up (December 2009–March 2011). They used a pre–post study design to assess changes in global CVD risk, individual CVD risk factors and statin prescription in patients with a complete and partial Health Check.

There were significant reductions in mean CVD risk score (28.2% to 26.2%), diastolic blood pressure, total cholesterol levels and lipid ratios after one year in patients with a complete Health Check. Statin prescription increas…