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Showing posts from March, 2013

Understanding variation in healthcare utilisation: start with health needs

In their paper on the effect of illness adjustment on regional mortality and spending rates using standard and visit corrected illness methods for adjustment, Wennberg and colleagues compare adjustment using diagnoses listed in administrative databases with additional adjustment for the frequency of doctors’ visits.1 They acknowledge that data on the use of healthcare cannot be used directly as a proxy for need or risk because these data also reflect differences in access to and supply of healthcare services. However, the methods of risk adjustment developed by these and other authors are based exactly on these data. Steventon’s editorial does not challenge this approach.2

Myself and Michael Soljak suggest in a letter published in the BMJ that this problem should be approached using the fundamental public health principle of disease prevalence in a population (“health needs assessment”). Good measures of the incidence and prevalence of disease known to primary healthcare services and…

Text4baby – a national mHealth programme

Text4baby is a mobile health (or mHealth) education programme sending free text-messages to women who are pregnant or have a young infant, that was launched in February 2010. The programme is a public–private partnership supported by a number of industry and public sector partners that include government agencies, the White House Office of Science and Technology Policy, corporations, academic institutions, professional associations and non-profit organizations. By covering all of USA and now spreading into other countries, such as Russia, it is the largest scale up of an mHealth intervention globally. In an article published in the Journal of the Royal Society of Medicine, Michelle Van Velthoven and colleagues concluded that As the first national programme of its kind, text4baby should be rigorously evaluated to ensure that pregnant women and their babies benefit from the programme, and that the programme truly becomes a role model for public–private partnerships in mHealth.

Pre end-stage renal disease care in Saudi Arabia

End-stage renal disease (ESRD) has emerged as an important public health issue worldwide, because of the marked increase in its incidence and prevalence. In a study published in the journal Diabetes Research & Clinical Metabolism, Amal Hassanien and colleagues examined pre-ESRC care in the Al-Noor Kidney Centre and Jeddah Kidney Centre in the western region of Saudi Arabia. Participants were patients with ESRD on regular haemodialysis during 2011. Main outcome measures were pre-ESRD care including: reason of referral to nephrology care, source of referral to nephrology care, duration of pre-ESRD care, and vascular access at the first dialysis; and primary causes of ESRD.

Preliminary indicators of pre-ESRD care showed that endocrine, nutritional and metabolic diseases, and immune disorders were the principal reason for patient referral. The predominant causes of ESRD were hypertension and diabetes. Hassanien and colleagues concluded that pre-ESRD care needs to be improved in Saudi…

Impact of reductions in primary care funding on the composition of the physician workforce

A well-established primary care sector has allowed England’s National Health Service (NHS) to make efficient use of resources through the gatekeeping role that general practitioners have in controlling access to specialist services. Because of the poor economic situation in the United Kingdom, there is now considerable pressure on the NHS to use its resources more efficiently. These financial challenges are putting enormous pressure on general practices at a time when the NHS is also going through other major structural changes. Consequently, general practitioners in England increasingly find themselves having to make difficult decisions about the future of their practices.

In an article published in the Journal of Ambulatory Care Management, I discuss the impact of these financial challenges on the career intentions of physicians. In recent years, primary care has been an attractive career choice for young physicians because of the flexible, diverse nature of the work and the relati…

General health checks increase the number of new diagnoses

In an article published in the journal Evidence Based Nursing, I comment on a recent Cochrane review of general health checks. These are checks that aim to detect risk factors and diseases in healthy people, with the aim of either preventing a disease from developing, or treating a disease earlier in its course. The systematic review of randomised controlled trials (RCTs) of general health checks found that they did not reduce morbidity or mortality, but did increase the number of new diagnoses. The review did though have several limitations. The trials included differed markedly in their definition of what constituted a ‘general health check’ and in the disease they were aiming to address. They also differed in how any newly identified risk factors or disease would be managed. In many studies, the only intervention offered was brief lifestyle advice. Some of the trials were also old, dating from the 1960s. Many of the currently available risk reduction interventions (such as the wid…