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Showing posts from 2010

MENA Diabetes Forum

I recently attended the Middle East and North Africa (MENA) Diabetes Forum, which was held in Dubai in December 2010. The countries in the MENA region have amongst the world's highest prevalence of diabetes, driven by rapid changes in income, lifestyle, diet and physical activity. The forum covered a range of issues, from prevention, early diagnosis, and effective treatment. There were also sessions in which policies from other countries, such as the UK, USA and Italy, were discussed so that these policies from other health systems could be examined to see what lessons they might offer the countries of the MENA region. Amongst the speaker were Professor Tawfik Khoja, Professor Jean-Claude Mbanya, Professor Salman Rawaf, Professor Ala Alwan and former US President William (Bill) Clinton. I spoke about the UK experience of implementing screening programmes for diabetes and the UK pay for performance framework that encourages primary care physicians to provide high-quality care to p…

Hospital admission rates for chronic obstructive pulmonary disease

A recent paper in the journal Thorax by Amaia Calderón-Larrañaga annd colleagues examined the association between hospital admissions for chronic obstructive pulmonary diseases (COPD) and population and primary health care factors. Hospital admission rates for COPD are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence. The study examined admission rates in 8,064 general practices in 152 English PCTs. Admission rates for COPD were strongly associated with population deprivation and smoking prevalence, whereas  healthcare factors such as influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective.

Suicide survey in a London borough

About one million people worldwide die each year from suicide. Hence, strategies to reduce deaths from suicide are a key public health priority in many countries. A recent study by Dennis Ougrin and colleagues published in the Journal of Public Health aimed to collate relevant data from local and national sources, which will demonstrate the incidence of death from suicide and undetermined injury in the London Borough of Brent. The study also aimed to determine the characteristics of the subjects dying of suicide and undetermined injury in the locality and to identify what structures and processes are in place for recognizing, monitoring and sharing information about suicide between primary care, secondary care and public health.

The authors identified all deaths by suicides and open verdicts in the residents of Brent between February 2005 and February 2008. Health records of the identified subjects were analysed by two researchers. The annual rate of suicide in the study period was 6…

Blood pressure monitoring and control by cardiovascular disease status in UK primary care

Cardiovascular diseases remain the main cause of morbidity and mortality in the UK. Strategies to reduce the burden of cardiovascular disease UK, such as the Quality & Outcomes Framework for general practitioners, have often emphasized improved management of high-risk individuals, rather than more population-based approaches to prevention. A recent study published in the Journal of Public Health Medicine by Anthony Laverty and colleagues from Imperial College London examined blood pressure monitoring and control among patients with and without cardiovascular disease in general practices in Wandsworth, London between 1998 and 2007. Logistic regression was used to assess associations among age, gender, ethnicity, deprivation and blood pressure control.
Laverty and colleagues found that the percentage of patients with elevated blood pressure (>140/90 mm Hg) decreased at a significantly slower rate in patients without cardiovascular disease (from 31.0 to 25.3%) compared with those w…

QOF Plus Programme wins London Award

Congratulations to Dr Josip Car and his team at NHS Hammersmith & Fulham for their work on the QOF Plus programme, which won the Award for Primary Care and Community Based Integration at the 2010 London Health and Social Care Awards. QOF Plus was developed jointly by the eHealth Unit at the Department of Primary Care and Public Health at Imperial and NHS Hammersmith and Fulham.
QOF Plus adopts a multi-modal approach based on:
Strong clinical leadership and shared ownership through clinical engagement and stakeholder panelsTargeted training and support Innovative funding, financial and other incentives Rigorous concurrent evaluation which feeds into constant self-improvement of the programmeCompetitive motivation using dedicated software analysis tools to allow regular performance review, benchmarking and prediction of end-of-year performancePatient-level management tools to assist practices in identifying those patients that may be missing out on particular interventionsSupport fo…

Statistical Genetics

Statistical genetics is a rapidly developing field that is producing models and methods for the analysis and interpretation of genetic data. Recent advances in new biotechnologies are generating detailed maps of genetic data are leading to potentially major developments in our understanding  of the genetic basis of health and disease. An example of research in this area is a paper published recently by one of our statisticians, Dr Utz Pape, in the journal Nature. In the paper, Dr Pape and his colleagues investigated the link between an genetically-linked enzyme defect and myeloid cancers.

An Overview of the Health System in Taiwan

An article published recently in the London Journal of Primary Care examined recent changes in the health system in Taiwan. Taiwan adopted a national health insurance system in 1995. Hence, both the British and the Taiwanese health systems are single-payment systems that offer universal coverage. However, the method of funding is different as the UK system is tax based, and the Taiwan system us other insurance-premium based. Now in its second decade, the National Health Insurance scheme in Taiwan continues to achieve high satisfaction rates among the Taiwanese people. Based on public opinion polls held by the Bureau of NHI, the overall satisfaction rate has consistently been over 70%.11 The next major challenge for the Taiwanese government is to improve quality of care while keeping national healthcare expenditure under control, and dealing with the rising number of older people in the Taiwanese population.

Supporting the development of GP Consortia in Northwest London

The National Institute for Health Research Collaboration for Leadership for Applied Health Research and Care (CLAHRC) for Northwest London recently held a networking event to explore potential links between the NW London CLAHRC and GP Consortia in London. Amongst the speakers were myself; David Stout, Director of the Primary Care Trust Network, NHS Confederation; Dr Alan Cohen, Director of Primary Care, West London Mental Health Trust; Professor Derek Bell, Director, NIHR CLAHRC for Northwest London; and Ganesh Sathyamoorthy, Head of Operations and Delivery, NIHR CLAHRC for Northwest London. My talk at this meeting was on what role public health specialists could play in the new GP consortia. There are a number of areas in which public health specialists could support the new GP consortia, including needs assessment, planning health services, implementing preventive health care programmes, and evaluation of new programmes.

Implications of White Paper for General Practitioners

In the period since the establishment of the new coalition government, we have seen radical changes proposed for the NHS in England. These are laid out in the new White Paper, Equity and Excellence: Liberating the NHS. These changes will have major implications for GPs and will lead to a period of major organisational change in the NHS in England. This is turn may lead to some general practices having less time to support non-core activities such as teaching and research.

GP contracts
The Government plans to abolish the current General Medical Services (GMS) and Personal Medical Services (PMS) contracts and bring in a new single contract for all general practitioners (GPs) in England. This new contract will include responsibility for commissioning health services. The White Paper also discusses linking GPs’ pay more closely to health outcomes (but it is currently unclear how this will be achieved in practice). The White Paper states that the Government ‘seeks over time to establish a s…

Trends in admission rates and in-hospital mortality for hip fractures in England

The incidence of hip fractures is an index of the overall burden of osteoporosis in a society. Hip fractures are a major cause of morbidity, mortality and hospital admissions amongst older people. A study published recently in the Journal of Public Health Medicine by Tai-Yin Wu and colleagues examined trends in hip fracture admissions and mortality in England. They found that between 1998 and 2009, there was little change in age-standardized hip fracture rates (102.0 to 101.8 fractures per 100,000 person-years), but age-standardized in-hospital mortality decreased by 17%, from 127 to 106 deaths per 1,000 hip fracture admissions. Most hip fractures and deaths occurred in women and older people. A socioeconomic gradient was present for mortality, with a 26% difference in mortality in 2008 (94 to 118 deaths per 1,000) between the most affluent and most deprived areas in England. As the number of older people in the population rises, hips fractures will continue to be an important public …

Impact of Pay-for-Performance on Disparities in Diabetes Management in UK Primary Care

Health systems like the UK's NHS aim to provide high-quality care for all groups of patients. Consequently, it is important to examine the impact of new initiatives in the delivery of health care on health disparities. A recent study by Fiona Hamilton and colleagues published in the Journal of Ambulatory Care Management examined the impact of a major pay-for-performance initiative introduced into UK primary care in 2004 on disparities in diabetes management. The study used data from the UK General Practice Research Database, which is widely used for epidemiological and health services research. The authors found that existing disparities in risk factor management (HbA1c, blood pressure, cholesterol) narrowed between men and women. Younger patients (under 45 years of age) with diabetes appear to have benefited less from Pay for Performance incentives than older patients, resulting in some widening of existing age group disparities. Patients living in affluent and deprived areas app…

2011 SAPC London Regional Meeting

The SAPC’s annual meeting of academic departments of general practice and primary care from London and the South East is a longstanding fixture in the academic calendar. The 2011 Meeting will be held from February 4-6 at Madingley Hall, Cambridge. The meeting is organised by the departments of primary care in the five main London medical schools. The 2011 meeting is being organised by the Department of Primary Care & Public Health at Imperial College London. For the 2011, our guest speakers include Dr Fiona Godlee (Editor of the BMJ), Professor Jan De Maeseneer (Professor of Family Medicine at the University of Ghent in Belgium); and Dr Roger Kneebone from the Department of Surgery & Cancer at Imperial College London. The meeting offers a good opportunity to present any research, development or teaching work that you have carried out in primary care. See the 2011 Meeting Website for further details.

Patient Reported Outcome Measures (PROMs)

There is increasing recognition on the importance of measuring outcomes in health care. One method of doing this is through the use of Patient Reported Outcome Measures (PROMs). These are indicators that measure quality from the patient perspective. A recent letter published in the British Medical Journal discussed the role of PROMs in promoting equity of access to elective health care. Preoperative measurement of PROMS, which is now routine for some NHS-funded procedures, can provide information about perceived needs and how this varies across referred populations by deprivation score or other socio-demographic factors. We already know that for some interventions, including hip replacement, postoperative improvement is strongly associated with preoperative PROM disease severity. This is demonstrated by data from the English hip replacement audit in the figure above. Using PROMs as part of an intervention threshold in elective surgery could improve both equity and efficiency, and thei…

Amputations in people with diabetes

Diabetic foot lesions remain a considerable cause of ill-health and a leading cause of hospitalization in people with diabetes. Unfortunately, despite intensive self-care and NHS treatment, many people with diabetes will eventually reach the stage when they need an amputation. Undergoing an amputation has a major social and psychological impact on patients, as well as considerable financial costs for health systems. In a recent study published in the journal Diabetes Care, Eszter Vamos and colleagues examined time trends in rates of amputation in people with diabetes aged over 16 years between 2004 and 2008 using national hospital activity from data from all NHS hospitals in England. They found an increase in the number of people with diabetes undergoing amputations. This was largely due to the increased prevalence (i.e. increased number of patients) with diabetes.  The findings illustrate the need to continue to improve the quality of care of people with diabetes to reduce the risk o…

Implementation of the NHS Health Checks programme

National Health Service Health Checks is a population-wide primary prevention programme for cardiovascular disease in England. The Department of Health began to implement the programme nationally in April 2009. The programme is delivered locally by primary health care teams and involves offering a ‘health check’ to all persons aged 40–74 years without diagnosed cardiovascular disease or diabetes. The health check includes measurement of body mass index (BMI), blood pressure, smoking status and lipid levels.

A recent paper published in the journal Family Practice examined the current level of risk factor recording in one part of London and how this varied with patient characteristics. The study also sought to quantify the likely workload for primary care teams in England of the new Health Checks programme. The study found that the recording of smoking status and blood pressure was very high in the electronic medical records of people without existing cardiovascular disease or diabetes.…

The Imperial College Obesity Strategy Assessment Framework (IC-OSAF)

Obesity is a major public health issue because of its increasing prevalence and impact on health. For example, as well as its impact on conditions such as high blood pressure and coronary heart disease, obesity is now also an important risk factor for cancer and liver dieases. The management of overweight and obesity has therefore been a government priority for many years. However, overweight and obesity management at a local level has often been ineffective. Although there is a need to examine obesity strategies and policies for local populations, there is currently no readily available framework for evaluating local obesity strategies. Researchers at Imperial College, led by Nik Tuah, therefore developed a framework, the Imperial College Obesity Strategy Assessment Framework (IC-OSAF), for examining the content of local obesity strategies.

The IC-OSAF was developed by adapting two previous policy analysis frameworks (Bardach’s Eightfold Path Framework and Collins’ Health Policy Anal…

Laparoscopic bariatric surgery in England

A study by Elaine Burns and colleagues published in the BMJ describes the large increase in NHS laparoscopic bariatric surgery operations observed in recent years, with an increase from 238 operations in 2000 to 2543 in 2007. Recent years have also seen large increases in NHS prescribing and spending on drugs for obesity. For example, a study published in the Journal of Public Health Medicine reported that between 1998 and 2005, Orlistat prescriptions in England rose 36-fold from 17,880 to 646,700 and their total cost increased by over 35-fold to £27 million. Sibutramine prescriptions rose from 53,393 in 2001 to around 227,000 in 2005, a 4-fold increase, at a cost of £11 million in 2005.Despite this increased spending on medical and surgical NHS interventions, rates of obesity continue to increase inexorably and around 25% of adults in England are now considered to be obese, with a BMI of 30 or greater.The failure of medical treatments for obesity is further illustrated by the subsequ…

Using information technology to improve patient safety

A recent World Health Organization (WHO) Working Group that I chaired examined the potential of information technology to improve patient safety. The report from the working group was published in the journal Quality & Safety in Healthcare. Previous research has identified as significant issues the substantial variations in the quality and safety of healthcare that patients receive; and the considerable risks of iatrogenic harm to patients. These failings contribute to the high rates of potentially avoidable morbidity and mortality; and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in recent decades and there is now real potential to apply these technological developments to improve the provision of healthcare.

One area of international interest is the use of eHealth applications to address patient safety and quality issues. There is, however, a large gap between the theoretical and em…

Independent sector treatment centres unlikely to be providing value for money

Independent sector treatment centres (ISTCs) were established by the previous government to increase the capacity for elective surgical procedures. The new centres were expensive and there are concerns about the value for money they provide. An article from York University published in the August issue of the Journal of the Royal Society of Medicine concluded that NHS hospitals were treating more complex patients than independent treatment centres. The article provides new information on private sector treatment centres that will help inform the policy of the coalition government. The article highlights the need for much tighter regulation of all units providing NHS services to ensure that they deliver high quality care, provide value for money, and meet minimum standards for data collection.

Other key findings from the article are that private sector treatment centres manage only a very small proportion of NHS-funded elective workload; their clinical coding is much poorer than that o…

Social networking: Not always beneficial for patients

New forms of communication have much to offer, and can help to improve the relationship between doctors and patients, as well as making patients more informed about their health and illness. In my own medical practice, we now offer online access to medical records and patients are starting to use this, particularly for ordering prescriptions and booking appointments. But there can also a downside to new technology, as shown by the recent incident of "bleachgate", which illustrates some of the problems that can arise from the use of these newer methods of communication, such as social networking. In this episode, a 15 year old boy from South Wales, Rhys Morgan, showing remarkable maturity and ability for some one so young, pointed out the problems that could be caused by a putative remedy for Crohn's disease that was being publicised on an online forum for people with Crohn's. Rather than being commended for his actions in exposing a dangerous treatment that could hav…

Impact of pay for performance on inequalities in health care

A recent systematic review by Riyadh Alshamsan and colleagues assessed the impact of pay for performance programmes, in particular the Quality & Outcomes Framework in the UK, on inequalities in the quality of health care. There was some evidence that the use of financial incentives reduced inequalities in chronic disease management between socio-economic groups. However, inequalities in chronic disease management between age, sex and ethnic groups persisted after the use of pay for performance incentives. They concluded that inequalities in chronic disease management have often persisted after the introduction of pay for performance programmes such as the Quality and Outcome Framework in the UK. The findings of the paper reinforce the need for pay for performance programmes to be designed to reduce inequalities as well as improve the overall quality of care.

CLAHRC Collaborative Learning and Delivery (CLD) Event

The Summer 2010 NIHR CLAHRC for Northwest London Collaborative Learning and Delivery Event was held at Imperial College on July 1.  The day was attended by over 160 delegates. The focus for the day was patient safety, with an international comparative perspective. We were fortunate in having a number of external speakers at the event, including a delegation of senior academics and clinicians from Taiwan.

The implementation of patient engagement and the quality and safety of the patient journey are key points of importance for the CLAHRC, this was reflected throughout the day in various keynote plenaries, workshops and support sessions. Featured plenary sessions from a range of keynote speakers included: Prof Derek Bell, Programme Director, NIHR CLAHRC for Northwest London; Prof Ken Kuo, Director, Division of Health Policy Research and Development, National Health Research Institutes, Taiwan; Dr Gill Hicks, MBE, Founder, M.A.D. for Peace; and Prof Peter Chang, Dean, Professor and Direc…

Reductions in risk factors for secondary prevention of coronary heart disease

The UK health care system provides universal coverage; hence, equitable health improvement across ethnic groups should be more easily attainable than in fragmented health systems. However, previous studies have shown ethnic health inequalities in cardiovascular disease prevalence, health outcomes and access to interventions and treatment in the UK. In a recent paper published in Family Practice, Joanna Murray and colleagues examined whether policy changes over the past decade in the primary care management of coronary heart disease (CHD), have resulted in improved and more equitable risk factor control among patients. The study was carried out in Wandsworth in South-West London.

They found that over a 10-year period from 1998 to 2007, mean blood pressure among patients with CHD decreased from 140/80 to 133/74 mm Hg, while their mean cholesterol was reduced from 5.2 to 4.3 mmol/l. Reductions in these risk factors occurred among both males and females and across all ethnic groups. The f…

COPD Prevalence Model for England

Diagnosed prevalence and morbidity data underestimate the total burden of chronic obstructive pulmonary disease (COPD) because the disease is usually not diagnosed until it is clinically apparent, and there is considerable variation in reported prevalence. Michael Soljak and colleagues have developed a multivariate model to estimate the expected prevalence of COPD in England, based on the data from the Health Survey for England, which can then used to produce local prevalence estimates. The results of this work were published in the Journal of Public Health. This COPD prevalence model is now available on the APHO Website and contains estimates of prevalence for general practices in England. The model is now being used a tool for COPD case finding.

Mortality in patients admitted as emergencies during weekends

A recent study in Quality & Safety in Healthcare by Paul Aylin and colleagues examined death rates in patients admitted as emergencies to NHS hospitals in England. This is the largest study published on weekend mortality and highlights an area of concern in relation to the delivery of acute services. Several studies have shown higher mortality for patients admitted as emergencies at weekends compared with emergency admissions on week days. Using routinely collected hospital administrative data, they examined in-hospital deaths for all emergency inpatient admissions to all public acute hospitals in England for 2005/2006. Odds of death were calculated for admissions at the weekend compared to admissions during the week, adjusted for age, sex, socioeconomic deprivation, comorbidity and diagnosis. The overall adjusted odds of death for all emergency admissions was 10% higher in those patients admitted at the weekend compared with patients admitted during a weekday The study was widely…

Trends in hospital admissions for adverse drug reactions in England

An adverse drug reaction (ADR) is an undesirable effect of a drug beyond its anticipated therapeutic effects occurring during clinical use, and is one of the major causes of iatrogenic disease. ADRs cause significant morbidity and mortality and increase the length of hospital stays. The economic burden of ADRs on the British NHS is also high, accounting for considerable extra NHS costs. A recent study by Dr Tai-Yin Wu and colleagues published in the Journal of the Royal Society of Medicine examined hospital admissions associated with ADRs in all NHS English hospitals in the past 10 years, using the Hospital Episode Statistics database.

Between 1999 and 2008, there were 557,978 ADR-associated admissions, representing 0.9% of total hospital admissions. Over this period the annual number of ADRs increased by 76.8% (from 42,453 to 75,076), and in-hospital mortality rate increased by 10% (from 4.3% to 4.7%). In 2008, there were 6,830,067 emergency admissions of which 75,076 (1.1%) were dru…

Using email to support health promotion in healthcare

A recent article by Helen Atherton, Christopher Huckvale and Josip Car in the Journal of Telemedicine and Telecare discussed the use of email in healthcare. The use of email as a method of transferring information between clinicians and patients is increasing. For example, email is now commonly used for the management of appointments and to provide test results. The widespread availability and use of email by the public creates opportunities for people to participate more actively in their own health care. One common use of email to support this is its use by primary care physicians to provide patients with additional information about disease prevention and health promotion, and thus reinforce the messages given during the consultation. The article confirmed that the use of email in healthcare developing rapidly, but also found that the evidence base to support the use of email is not well established, and that better research was needed if we are to maximise the benefits of this tec…

Geographical planning of primary care in England

A recent article in the journal Primary Health Care Research & Development By Edgar Samarasundera and colleagues discusses the use of socio-demographic data sources for monitoring local health profiles and for use in the geographical planning of primary health care in England. The article updates an older paper published in the BMJ in 1995.

There is an increasing range of resources available for geographical analyses in health. The 2001 census introduced important changes to what routine data are available, as will the 2011 census. These changes have been paralleled by developments in the availability of socio-demographic indicators and the increasing popularity of geographic information systems. Health data can now be combined with those from socio-demographic more efficiently to produce value-added datasets.

Recent and planned developments in the availability of both socio-demographic datasets in tandem with parallel developments in spatial technologies have provided a flexible,…

Scientific workflows for primary care database studies

A scientific workflow is a method in computer science for formulating abstract descriptions of analytical processes. This allows automation and reuse of many of the tasks in analysing large, complex data sets. A recent article in the journal Statistical Methods in Medical Research discussed the use of these scientific workflows for the analysis of data from large primary care databases.

Routinely collected primary care data in electronic repositories are a promising source of data for audits, quality improvement, health service planning, epidemiological studies and research. However, a number of challenges have been noted about working with these data sets. In the paper, we discuss these issues and describe how we used scientific workflows to analyse data from one large primary care database (GPRD). Some of the steps in the analysis of data from the GPRD our shown in the figure below.

Improving pharmacovigilance using routinely collected data

In a recent BMJ editorial, Nicholas Moore and Bernard Begaud outline initiatives to improve pharmacovigilance in Europe. Such initiatives are essential to improving the safety of healthcare because current approaches to detection of serious adverse drug reactions (ADRs) have major limitations. Serious adverse drug reactions are often too rare to be detected in early clinical trials, and may not be detected through post-marketing surveillance for many years. This delay in identifying adverse drug reactions leaves clinicians unaware about the potential risks of the drugs they are prescribing, puts patients at risk of iatrogenic harm, and increases both healthcare costs and the costs of drug development.

The development of databases derived from electronic patient records and hospital administration systems could help to improve the detection of adverse drug reactions. In England, these databases include the General Practice Research Database (GPRD), The Health Improvement Network (THIN…

Imperial College Publications Page

I am sometimes asked where a list of my academic publications can be found? Details of my publications can be found on my Imperial College Publications Page. This is updated automatically - at regular intervals, a search of the PubMed and other bibliographic databases is carried out and any publications with an author matching my details are flagged for me to decide whether they are included on the page. The advantage of using this page to view my list of publications - rather than a PubMed search - is that there are other authors with similar details to me. Hence, a PubMed search will include publications from other authors and not just those which are mine.

Accuracy of coding of diabetes

The incorrect classification, diagnosis and coding of the type of diabetes can affect the quality of health care that people with diabetes receive. A study published recently in the journal Diabetic Medicine examined the accuracy of diagnostic data on diabetes. The study found that errors in the coding and classification of diabetes were common. The study included some useful algorithms to help doctors identify which patients may not have their diabetes recorded correctly.

Research Assistant - TRANSFORM Project

An opportunity has arisen for either a Research Assistant or Research Associate to join an international/cross-discipline team creating a rapid learning healthcare system to improve patient safety and volume of clinical research in Europe. This is an exciting opportunity for an individual with a keen interest in data mining and/or data provenance who is looking to gain experience in medical informatics. The aim of the research is to design and develop an extensible provenance framework to be integrated into the decision support and data mining engines to ensure auditability and accountability. This position will be responsible for investigating existing provenance models and their applicability to data mining tasks and contributing to the development of novel data mining models for translational data. See the Imperial College Recruitment Page for further details.

Public Financing of Health in Developing Countries

I attended a conference today hosted jointly by the Imperial College’s Institute for Global Health and the Lancet which discussed public financing of health in developing countries. The centre-piece of the conference was a presentation by Professor Christopher Murray of the paper published by him and his colleagues in the Lancet. The main conclusion of Professor Murray’s study was that development assistance for health from donor countries can lead to a reduction in direct government spending on health in developing countries. In contrast, when development assistance for health was given to non-governmental organisations, this effect was not present. The study was a very impressive achievement, particularly given the limitations of the data that Professor Murray’s team had to use. The study raises some important questions for both donor countries and recipients of development assistance for health.

Has pay for performance improved the management of diabetes in the UK?

A recent article in Primary Care Diabetes examines the question of whether pay for performance has improved the management of diabetes in the United Kingdom. Over the past decade, the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance programme for general practices launched in April 2004. The QOF aimed to improve the primary care management of common chronic conditions including diabetes. The introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies have adjusted for underlying trends in quality. QOF may also have reduced inequalities in diabetes care between affluent and deprived areas. Less is known about the impact of QOF on aspects of diabetes care …

London RDS Session at the Reynolds Building

The London Research Design Services will be holding a drop-in session at the Reynolds Building on Thursday March 25 2010. RDS London provides guidance and support to clinicians and academics preparing grant applications to he NIHR. The drop-in sessions are open to all, whether you just want to find out more about the service or would like to discuss a proposal with one of RDS London’s experts. There will be a number of RDS advisers available on the day that will be able to offer you advice on all aspects of your proposal.

Lecture at the University of Tokyo

Last week, I attended a seminar at the University of Tokyo, organised by the Todai Policy Alternatives Research Institute. I spoke about the secondary uses of data from electronic patient records in the UK (the primary use is defined as their role in providing direct clinical care). Also speaking at the conference were John Halamka from Harvard and Nikolaus Forgo from Hanover, as well as speakers from the University of Tokyo, such as Professor Morita, Professor Akiyama, and Professor Sakata. Amongst the audience of 250 were representatives from clinical medicine, academia, government and health service management. I was very impressed by the expertise and commitment to this area of work in Japan. You can view a summary of the proceedings in Japanese.

Impact of universal health coverage in the UK on health disparities

There is currently an ongoing debate in the USA about whether the US government should expand health coverage to include some groups that have limited access to health care. In the UK, we have had universal health coverage since 1948, when the NHS was introduced. The US health system has some stark disparities between ethnic groups. A recent article from Imperial College published in the Journal of Public Health examined change in the quality of care for people with diabetes over a 10 year period from 1997-2006. We found that although Although ethnic disparities persist in diabetes management, these are starting to be addressed, particularly in the South Asian group. It appears therefore that all ethnic groups have benefited from recent quality improvement initiatives in the UK.

Moving forward on the use of EPRs for research

A recent article in Informatics in Primary Care discussed how we can build on a Wellcome Trust report on the use of electronic patient records (EPRs) from general practice for research. The UK could significantly enhance its health research capability by making effective use of data from electronic patient records for secondary research. The Wellcome Trust report provides useful guidance to researchers and clinicians on why secondary research using data from electronic records in primary care is important. Combined with advances in NHS Information Technology systems, particularly the Research Capability Programme, and financial support from the NIHR, we need to make this potential a reality and ensure that the UK remains a world leader in primary care informatics.

The burden of alcohol related disease

A recent report from the NHS Confederation and the Royal College of Physicians examines the growing cost to the NHS of treating people with alcohol-related diseases. The report was also covered by the BBC News. One of the important complications of excessive alcohol intake is liver disease.

In a paper published in 2008 in the journal Alcohol and Alcoholism, along with colleagues from St.Georges Hospital and the Office for National Statistics, I examined trends in hospital admissions and mortality in England from chronic liver disease. Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females between 1989 to 2003. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. Mortality rates for chronic liver disease more than doubled between 1979 and 2005 with two thirds of these deaths attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic liver …