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Showing posts from September, 2013

Improving Access to Psychological Therapies and antidepressant prescribing rates in England

Antidepressant prescribing rates in England have been increasing since the 1970s. The impact of the Improving Access to Psychological Therapies (IAPT) initiative on antidepressant prescribing rates is unknown. In a paper published in the British Journal of General Practice, Vaishnavee Sreeharan and colleagues from Imperial College London investigated the impact of the establishment of IAPT services on antidepressant prescribing rates in primary care trusts (PCTs) in England.  They used a longitudinal time-series analysis, using PCT-level data from 2008 to 2011. They reported that antidepressant prescribing rates in England increased by 10% per year during the study period. The implementation of IAPT services had no significant effect on antidepressant prescribing. They concluded that the introduction of a large-scale initiative to increase provision of psychological therapies has not curbed the long-term increased prescribing of antidepressants in England. You can read commentaries o…

Fairer Funding Model Needed for UK General Practice

In an article published in the Journal of the Royal Society of Medicine, I discuss some of the current challenges facing general practitioners in the UK, such as rising workload, increasingly complex patients, and reductions in budgets. In the article, I also discuss options for tackling these challenges. These include a fairer funding model for general practice that links patients needs and practices' workloads more closely to funding. Other options discussed in the article include the creation of practice federations or 'super partnerships' and the transfer of GPs from their current independent contractor status to becoming NHS employees on similar terms to other senior doctors working for the NHS. Many GPs (including my own colleagues in South London) are struggling to manage their workload with their current practice budgets; and this could have serious implications for patients, the public and the NHS. We do therefore need a serious debate about the future of primary…

Patient and Public Views on Electronic Health Records and Their Uses

The development and implementation of electronic health records (EHRs) remains an international challenge. Better understanding of patient and public attitudes and the factors that influence overall levels of support toward EHRs is needed to inform policy. In a paper published in the Journal of Medical of Medical Internet Research, Serena Luchenski and colleagues reported the findings of a study that explored patient and public attitudes toward integrated EHRs used simultaneously for health care provision, planning and policy, and health research.

They carried out a cross-sectional questionnaire survey administered to patients and members of the public who were recruited from a stratified cluster random sample of 8 outpatient clinics of a major teaching hospital and 8 general practices in London . 5331 patients and members of the public responded to the survey, with 2857 providing complete data for the analysis presented here. There were moderately high levels of support for integrat…

The provision and impact of online patient access to their electronic health records (EHR) and transactional services

A paper published in the journal Informatics in Primary Care describes the protocol for a systematic review of the provision and impact of online patient access to their electronic health records (EHR) and transactional services on the quality and safety of health care. The review aims to assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care. Developers have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across Eng…

Cancer diagnosed by emergency admission in England

Patients diagnosed with cancer by the emergency route often have more advanced diseases and poorer outcomes. Rates of cancer diagnosed through unplanned admissions vary within and between countries, suggesting potential inconsistencies in the quality of care. To reduce diagnoses by this route and improve patient outcomes, high risk patient groups must be identified. In a paper published in BMC Health Services Research, Carmen Tsang and colleagues report the results of a cross-sectional observational study that determined the incidence of first-ever diagnoses of cancer by emergency (unplanned) admission and identified patient-level risk factors for these diagnoses in England.

Data for 74,763 randomly selected patients at 457 general practices between 1999 and 2008 were obtained from the General Practice Research Database (GPRD), including integrated Hospital Episode Statistics (HES) data and Office for National Statistics (ONS) mortality data. The proportion of first-ever diagnoses by…