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Showing posts from December, 2012

Email communication between patients and healthcare professionals

Although email is now a very commonly-used method of communication, its use in health care is not yet routine. Email has been used for communication of clinical information between patients and healthcare professionals, but the effects of using email in this way are not known. In a recent review published by the Cochrane Collaboration, Helen Atherton and colleagues assessed the use of email for two-way clinical communication between patients and healthcare professionals. Atherton and colleagues concluded that the evidence was limited it was not possible to adequately assess the effect of email for clinical communication between patients professionals. They advised that future research should take into account the changing nature of technology when designing and conducting future studies and barriers to trial development and implementation should also be tackled. Potential outcomes of interest for future research include clinical effectiveness, cost-effectiveness and use of health ser…

Guardian article on cuts to primary care budgets

A recent article in the Guardian newspaper by Juliette Jowit discusses the potential impact on patient care on cuts to primary care budgets. The article quotes from my experience as a general practitioner in Lambeth.

"People will start to go to A&E: that costs a lot more and puts a strain on hospitals," he said. "And there's evidence from a number of studies that the better access to GPs is, the better you get in terms of low rates of inpatient admissions for things like strokes [and] lung infections. You end up with poorer health, more cases of hospital care and higher costs."

I also discussed these issues in a recent article in the British Journal of General Practice.

Differences in BP control using NICE guidelines and QOF targets

High blood pressure is the main risk factor for cardiovascular disease. As cardiovascular risk is directly associated with blood pressure levels, the aim of interventions is to lower blood pressure. This aim results in a definition of the control of blood pressure which is currently understood as an achievement of specific blood pressure levels or targets. These targets have been established in different guidelines based on the consensus views of experts. In a study published in JRSM Short Reports, Lena Barrera and colleagues compared differences in the classification of hypertensive controlled patients between the quality indicator established in QOF guidance and the clinical target recommended in NICE guidelines using data from general practices in London.

They found that 80% of patients were classified as controlled by the QOF target and 1% by the NICE target. 93% and 14% of practices had more than 70% of patients classified as controlled using the QOF and NICE targets respectivel…

Primary care in England: an era of austerity

General practitioners (GPs) in England are currently facing perhaps their most challenging financial circumstances since the NHS was founded in 1948. In an editorial published in the British Journal of General Practice, I discuss these the very difficult financial environment that general practitioners find themselves in. GPs will find themselves caught between the priorities of clinical commissioning groups (CCGs) and the NHS Commissioning Board; with CCGs requiring ever greater efficiencies in the use of secondary care services; and the NHS Commissioning Board demanding more ‘value for money’ from general practice contracts.

A strong primary care sector has allowed the NHS to make efficient use of resources, through the gatekeeping role that GPs have in controlling access to specialist services, and through the wide range of medical, social, and psychological problems that GPs and their teams manage through a mix of person-based and population-centred care. The impact of cuts in pr…

Obstructive sleep apnoea, obesity and snoring

Obstructive sleep apnoea (OSA) affects between 2-3% of the population of the UK.  Interestin OSA has increased because of its association with hypertension, type 2 diabetes mellitus and coronary artery disease, and adverse health outcomes. In an article published in the Primary Care Respiratory Journal, Ravi Parekh and colleagues discuss the association of OSA with obesity and snoring.