Skip to main content

Does higher quality primary health care reduce stroke admissions?


Hospital admission rates for stroke are strongly associated with population factors. The supply and quality of primary care services may also affect admission rates, but there is little previous research on this association. In a paper published recently in the British Journal of General Practice, Michael Soljak and colleagues from the Department of Primary Care & Public Health at Imperial College London investigated whether the hospital admission rate for stroke is reduced by effective primary and secondary prevention in primary care.

This was a national cross-sectional study in an English population (52 763 586 patients registered with 7969 general practices in 152 primary care trusts). They found that mean annual stroke admission rates per 100 000 population varied from zero to 476.5 at practice level. In a practice-level multivariable Poisson regression, observed stroke prevalence, deprivation, and smoking prevalence were all risk factors for hospital admission. Protective healthcare factors included the percentage of stroke or transient ischaemic attack patients whose last measured total cholesterol was ≤5 mmol/l, and ability to book an appointment with a GP.

They concluded that the associations of stroke admission rates with deprivation and smoking highlight the need for effective smoking-cessation services. Patient experience of access to primary care may also be clinically important. In countries with well-developed primary healthcare systems, the potential to reduce hospital admissions by further improving the clinical quality of primary healthcare may be limited unless more rigorous quality improvement measures than those currently being used are implemented.

Comments

Popular posts from this blog

Example ADHD Referral Letter

Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have

Dr Curran and Partners – Clinical Update 10 August 2023

1. Measles The UKHSA has warned that unless MMR vaccination rates improve, London could experience a large measles outbreak. Measles is potentially a very serious illness with important complications - but is preventable though vaccination.  Please ensure patients and their families are up to date with their vaccinations. Please also check the vaccine status of new patients - particular migrants - and enter details onto the medical record of any vaccines given elsewhere. https://www.gov.uk/government/news/london-at-risk-of-measles-outbreaks-with-modelling-estimating-tens-of-thousands-of-cases 2. Shingles vaccination The shingles vaccine programme is being expanded. From September, GP practices will offer: - Those aged 70-79, 1 dose of Zostavax or 2 doses of Shingrix - People aged 50+ with a weak immune system, 2 doses of Shingrix - Those turning 65 & 70, two doses of Shingrix vaccine. For further details, see https://www.gov.uk/government/publications/shingles-vacc

Why we need to put an end to the GANFYD culture in the UK

One of the causes of increased workload in general practice are the many requests that doctors get for letters, reports and forms from patients or from external organisations. It’s now so common that doctors have coined a term for it: GANFYD – Get A Note From Your Doctor.  It’s seems that large sections of society can’t function without these “letters from doctors”. Instead of using common sense or employing their own clinical advisers, external organisations make repeated requests to NHS doctors for letters which are often not at all needed. Often the worst offenders come from the public sector – e.g. universities who seem to look upon NHS general practice as a source of free occupational health advice for their students. Universities never – of course - offer to pay for this advice they get from NHS GPs. Instead, university requests will come with a mealy-mouthed statement that any fee is the responsibility of the student. Like doctors are going to impose heavy fees on impoverished s