Medical Centre

I now also have a blog on the BMJ Group's Doc2Doc site. The doc2doc site is an networking community for healthcare professionals.

Primary health care services are important in establishing an effective, efficient, and equitable health system and in improving population health. This has led governments in many countries to increase their investment in primary care and introduce initiatives to improve quality, such as pay for performance. In the United Kingdom, this includes the Quality & Outcomes Framework (QOF), a national pay for performance programme. There is interest in devolving some aspects of national pay for performance programmes to local primary care organisations, to give greater flexibility and the ability to focus on local priorities. In a recent BMJ paper, Christopher Millett and colleagues discuss one such local programme, QOF+ , which was implemented in NHS Hammersmith & Fulham . The review of the scheme in NHS Hammersmith & Fulham suggests that local pay for performance incentive schemes may allow for opportunities to improve quality, encourage innovation, and tackle local public h...

Prescribing for older people is complex and can lead to inappropriate prescribing, as well as side effects from prescribed medication. With a growing number of older people in the population, strategies to improve prescribing in this group are needed. Older people living in care homes are particularly at risk from polypharmacy and inappropriate prescribing. In a recent article published in the journal Age and Ageing , Malar Loganathan and colleagues reviewed the effects of interventions to optimise prescribing for people living in care homes. Four interventional strategies were identified from previously published research: staff education, multi-disciplinary team (MDT) meetings, pharmacist medication reviews and computerised clinical decision support systems (CDSSs). Complex educational programmes that focused on improving patients' behavioural management and drug prescribing were the most studied area, with six of eight studies highlighting an improvement in prescribing....

Many health systems are investing heavily in IT-based systems that aim to improve the quality and safety of health care. For example, England has invested at least £12.8 billion in a National Programme for Information Technology (NPfIT) for the National Health Service, and the Obama administration in the United States (US) has similarly committed to a US$38 billion eHealth investment in health care. Examples of such investment include electronic health records (EHRs), picture archiving and communication systems (PACS), electronic prescribing (ePrescribing) and associated computerised provider (or physician) order entry systems (CPOE), and computerised decision support systems (CDSSs). Policy makers hope that this investment will help address the problems of variable quality and safety in health care delivery. However, the scientific basis of such claims—remains to be established. A recent systematic review by Ashly Black and colleagues published in the journal PLoS Medicine aimed to...