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Showing posts from January, 2014

Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements …

Effect of financial incentives on delivery of alcohol screening and brief intervention in primary care

Alcohol screening and brief intervention (ASBI) is effective but often under-provided in primary care. Financial incentives may help address this. We assessed the impact of a local pay-for-performance programme on delivery of ASBI in UK primary care in a longitudinal study using data from 30 general practices in North-West London from 2008 to 2011 with logistic regression to examine disparities in ASBI delivery. The study was published in the Journal of Public Health.
Of 211 834 registered patients, 45 040 were targeted by the incentive (cardiovascular conditions or high risk; mental health conditions), of whom 65.7% were screened (up from a baseline of 4.8%, P < 0.001), compared with 14.7% of non-targeted patients (P < 0.001). Screening rates were lower after adjustment in younger patients, White patients, less deprived areas and in patients with mental health conditions (P < 0.05). Of those screened, 11.5% were positive and 88.6% received BI. Men and White patients were si…

Over two million people in England may be eligible for surgery to treat obesity

Over two million people in England may be eligible for surgery to treat obesity, according to new research published in JRSM Open. However, fewer than 7000 patients underwent these procedures in 2011.

Carrying out more bariatric surgery procedures would help to reduce obesity-related ill health, the study authors from Imperial College London said, but the NHS may need to invest in more resources to meet demand.

Bariatric surgery – a set of surgical procedures performed on obese people to decrease their stomach size – can greatly reduce the likelihood of death from obesity-related diseases such as type 2 diabetes, stroke or coronary heart disease.

Despite clear guidelines outlining who can undergo such surgery with the NHS, and evidence that these procedures are cost-effective in the long run, less than one per cent of those eligible have weight loss surgery each year. The researchers say this raises questions about why more procedures are not currently being carried out.

One possible…

Blood pressure study points to more equitable care in England than America

In the USA but not in England, patients on low incomes with high blood pressure have their condition managed poorly compared with those who earn more.

A new study from my department comparing blood pressure management in the US and England found that although there is little difference between the two countries overall, the level of socioeconomic inequality is much higher in the US, with wealthier Americans more likely to meet targets for bringing their blood pressure under control than poorer patients. The study was published in the journal PLOS ONE.

High blood pressure, or hypertension, is the leading cause of ill health worldwide and affects 76 million people in the US and 16 million in the UK. It is diagnosed if someone’s blood pressure consistently measures 140/90 millimetres of mercury or higher. Doctors usually recommend lifestyle changes to control blood pressure, and may prescribe antihypertensive drugs.

The research aimed to determine whether differences between the British…