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Showing posts from October, 2013

Life expectancy at birth and at age 65 in England and Wales

Life expectancy at birth has been used as a measure of the health status of the population of England and Wales since the mid-nineteenth century. Recently published statistics from the UK Office for National Statistics show that the long-standing North-South divide in distribution of life expectancy across England continues, with people in the North of England generally living shorter lives than those living in the south.

Life Expectancy at Birth
Male life expectancy at birth was highest in East Dorset (82.9 years) and lowest in Blackpool (74.0 years). For females, life expectancy at birth was highest in Purbeck at 86.6 years and lowest in Manchester at 79.5 years. Life expectancy at birth increased across England and Wales by 1.3 years for males and 1.0 year for females between 2006–08 and 2010–12. This is part of a long-standing trend of improving life-expectancy, which is leading to a gradual increase in the average age of the population of England and Wales, and the elderly forming…

Cancer has replaced cardiovascular disease as the commonest cause of avoidable mortality

A recent analysis of causes of potentially avoidable deaths in England and Wales by the Mortality Team at the Office for National Statistics (ONS) showed that cardiovascular diseases were the largest cause of avoidable deaths between 2001 and 2006. In 2007, cancers became the leading cause of avoidable deaths and have remained so since then.

This change in ranking has occurred because deaths from cardiovascular diseases have been falling for many years. Deaths from cancer in contrast have been falling much more slowly than deaths from cardiovascular disease and cancer has therefore now become the commonest cause of avoidable deaths. The rapid decline in age-standardised death rates from cardiovascular diseases have been driven by a range of factors. These include medical (e.g. statins) and surgical treatments (e.g. angioplasty); and changes in lifestyle (such as a reduction in the prevalence of smoking).

The findings of this very useful analysis by the ONS illustrate the need to maint…

mHealth project in Zhao County, rural China

In a paper published in the Journal of Global Health, Michelle van Velthoven and colleagues describe a a collaboration between researchers in China and the UK that aimed to explore the use of mHealth in China. This is the first paper in a series of papers on a large mHealth project part of this collaboration. This paper includes the aims and objectives of the mHealth project, our field site, and the detailed methods of two studies. This large mHealth project is part of a collaboration between researchers in China and the UK. The mixed methods study evaluating factors that influence sample size calculations could help future studies with estimating reliable sample sizes. The cross–over study comparing face–to–face and text message survey data collection could help future studies with developing their mHealth tools.

Simon Stevens appointed as the Chief Executive of the NHS in England

Simon Stevens has been appointed as the new Chief Executive of the NHS in England and will start in his post in April 2014. Stevens is the Executive Vice President of UnitedHealth Group and President for Global Health. He has been based in the USA in recent years. He has formerly worked as a NHS manager in England and as an adviser to Tony Blair when he as Prime Minister. Professor Malcolm Grant, Chairman of NHS England, said that Mr Stevens was the best man for the job because he could bring experience from many different models of healthcare delivery. His appointment has brought a mixed reaction in England. Many people view his appointment as NHS Chief Executive as a positive step, viewing him as someone who will bring innovative ideas and ways of working. Others are more wary and are concerned he may push further marketization and models of healthcare delivery derived from the USA.

Sophie Coronini-Cronberg invited to join Royal College of Ophthalmologists Working Group

Following the publication of her paper, "Evaluation of clinical threshold policies for cataract surgery among English commissioners", in the Journal of Health Services Research and Policy, Sophie Coronini-Cronberg (Honorary Clinical Research Fellow in the Department of Primary Care & Public Health at Imperial College London) has been invited by the Royal College of Ophthalmologists to join its working group responsible for developing cataract surgery commissioning guidance. The work is due to be completed by the end of this year.

Health policies should incorporate public health priorities

In a letter published in the British Medical Journal (BMJ), Michale Soljak, Chris Millett and I discuss the call by Krogsbøll to abandon the NHS Health Check Programme.As members of one of the research teams evaluating the national programme, we challenge their view that a randomised controlled trial (RCT) of the current programme should be the sole arbiter on which to base national health policy decisions. As noted in comments on the Cochrane review, the dearth of RCTs of screening for cardiovascular (CVD) risk since 1999 is unfortunate, but there were many RCTs of individual screening components over this period that have been used in subsequent NICE guidance.

There are other reasons why Krogsbøll et al’s views should be challenged. Firstly, RCTs are expensive and time-consuming, and as a result, a lack of evidence from RCTs may deprive millions of people of potential benefits from interventions.  RCTs should therefore be complemented where possible by well-validated modelling stud…

Arguments in Favour of a Salaried GP Service

The independent contractor model has been at the core of general practice in the UK since the NHS was first established and this model has many strengths. For example it has allowed the development of a s strong primary care sector that has allowed the NHS to operate efficiently - NHS general practices have typically used between 8-10% of the total NHS budget and dealt with up to 90% of all patient contacts with the NHS. However, in recent years, general practices have come under increasing pressure through a combination of rising workload, increased complexity of care, and a reduction in the resources allocated to primary care.

Many general practitioners now find themselves struggling to cope with their day to day workloads. This makes it difficult for patients to gain timely access to their general practices and in turn increases pressure on other parts of the NHS, such as Emergency Departments. We are also now seeing a divide developing in the profession between salaried GPs and G…

Text messages can help prevent type 2 diabetes

Text messages that encourage the recipient to eat healthily and exercise can help prevent type 2 diabetes in people at high risk, a study has found. Researchers from Imperial College London and the India Diabetes Research Foundation recruited 537 men in South-East India with impaired glucose tolerance, a condition that commonly precedes type 2 diabetes. Half received frequent text messages reminding them to eat healthily and be physically active, while the other half had standard care from their doctor.

After an average of 20 months’ follow-up, 18 per cent of the text message group developed type 2 diabetes, compared with 27 per cent of the control group. The findings were published in the journal Lancet Diabetes and Endocrinology. The messages included practical tips for healthy eating and reminders about the importance of exercise. They were also tailored to the individual’s behaviour. Those with the most unhealthy lifestyles were given information about the benefits of good habits…

Arguments in Favour of an Independent Contractor Model of General Practice

I have written an article on why GPs should consider giving up their independent contractor status and become NHS employees, which was published in Pulse. In this blog post, I will make the opposing argument and will list reasons why we should retain the current independent contractor model of general practice. This will be helpful for those GPs who are against the proposal that we should become NHS employees but who are unable to put together a coherent or logical counter-argument. If anyone has further arguments in favour of the independent contractor model, please let me know and I will add them to the list.

1- The independent contractor model is very efficient. For between 8-10% of NHS spending, general practices deal with up to 90% of patient contacts in the NHS.

2- Because GPs are not NHS employees, they have more freedom to act as patient advocates and to speak up about deficiencies in the NHS.

3- The independent contractor model gives GPs a stake in their practices and encour…

Low rate of adverse events recorded in English primary care

A study by Dr Carmen Tsang and colleagues at Imperial College London has found a low incidence of patient safety incidents recorded in general practice. The research, which was published by the British Journal of General Practice, measured the extent of patient safety incidents recorded in 74 763 patients at 457 English general practices between 1999 and 2008, and the patient characteristics associated with these adverse events.

Older patients, those with more comorbid diseases or who had more previous emergency admissions to hospital were at greater risk of complications of care. Dr Carmen Tsang, lead author of the paper, says “Our finding of a low incidence of patient harm in general practice supports previously published studies. To better understand these adverse events, we must also examine the healthcare interactions from which they originate, and consider how to reduce the incidents that are potentially preventable”.

Outcomes following adverse events, including emergency admis…