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Showing posts from February, 2014

Higher quality primary healthcare associated with reduced hospital admissions for diabetes complications

In a study led by Imperial College London and published online in the journal Diabetic Medicine, researchers from the Department of Primary Care & Public Health at Imperial College London examined if hospital admission rates for diabetes complications (acute complications, chronic complications, no complications and hypoglycaemia) were associated with the management of diabetes in primary care.

We performed an observational study in the population in England during the period 2004–2009 (54 741 278 people registered with 8140 general practices). We used multivariable negative binomial regression to model the associations between indirectly standardized hospital admission rates for complications and primary healthcare quality, supply and access indicators, diabetes prevalence and population factors.

In multivariate regression models, we found that increasing deprivation and diabetes prevalence were risk factors for admission, while most healthcare covariates, i.e. a larger practice…

High potency statins linked to better outcome following a heart attack

A study looking at the data of thousands of patients who suffered heart attacks has suggested treatment with high-potency statins offers a significantly improved chance of survival compared to those taking normal statins. Results of the study were published online in the journal Heart.

The study, led by the University of Dundee and on which I was a collaborator, also found a combination of statins and the drug ezetimibe showed no improved survival rate, although researchers caution this finding needs further testing.

'There is presently a lot of interest in ezetimibe as a potential treatment for heart patients,' said Professor Chim Lang, from the Division of Cardiovascular and Diabetes Medicine at the University of Dundee Medical School.

'Ezetimibe has been shown to be very effective at lowering cholesterol but we do not know its effect on survival. The key question really is whether it is better than statins, especially high potency statins such as rosuvastatin or atorva…

Funding for GP services for people living in care homes

The Chief Inspector of Primary Care, Dr Steve Field, has criticised GPs for charging ‘retainer’ fees for treating patients in care homes. Perhaps Dr Field is unaware that the current funding mechanism for general practice does not reflect the needs of patients with complex health problems such as those patients living in care homes? The current capitation-based payment is insufficient to fund the level of primary care support these patients need from primary care teams and should be supplemented by need-based funding. The GMS weighted capitation formula used to allocate resources to general practices is a blunt instrument and does not work well for the small groups of patients with complex health needs. For these groups of patients, needs-based funding mechanisms are more appropriate.

Patients living in care homes have complex health problems that require significant input from GPs and community staff, as well as skilled care from the nurses who work in care homes. Residents of care …

MPH Student Presentations on the NHS Care.Data Programme

As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments:

Arguments for the Ca…