Medical Centre

There are marked inequalities in cardiovascular disease (CVD) incidence and outcomes between ethnic groups. CVD risk scores are increasingly used in preventive medicine and should aim to accurately reflect differences between ethnic groups. Ethnicity, as an independent risk factor for CVD, can be accounted for in CVD risk scores primarily using two methods, either directly incorporating it as a risk factor in the algorithm or through a post hoc adjustment of risk. In a study published in the journal Ethnicity & Health , Andrew Dalton and colleagues compared these two methods in terms of their prediction of CVD across ethnic groups using representative national data from England. They carried out a cross-sectional study using data from the Health Survey for England. We measured ethnic group differences in risk estimation between the QRISK2, which includes ethnicity and Joint British Societies 2 (JBS2) algorithm, which uses post hoc risk adjustment factor for South Asian men. ...

Researchers from Imperial College London and the Nuffield Trust have published the findings from an evaluation of the first year of a project designed to deliver more integrated care to patients in North West London. The Inner North West London Integrated Care Pilot is a large-scale programme focused on developing new models of care planning and coordination for people with diabetes and those who are over 75 years of age. The pilot is being implemented at a time of major reform of the NHS in England, and has been the subject of significant attention among policy makers and commissioners wanting to encourage new models of integrated care. The benchmarks set in this first evaluation report provide a sound basis for the pilot to assess its progress against, particularly in relation to activity, cost, and health outcomes. The pilot was evaluated by Imperial College London and the Nuffield Trust between September 2011 and July 2012, with funding from the Imperial College Healthcare Char...

The ability to consult by telephone is now an integral part of any modern patient-centred healthcare system and the British Medical Association (BMA) has provided guidance for general practitioners ( Consulting in the modern world , which was published in 2001). The BMA concludes that "telephone consultations when correctly conducted can be considered to be safe and acceptable practice". In a protocol for a Cochrane Review , Rumant Grewal and colleagues explain how they will identify and measure the effectiveness of interventions that aim to improve the clinician telephone consultation skills of clinicians. Grewal and colleagues believe that their review will provide evidence about the most effective interventions for improving telephone consultation skills and thereby improve both quality of care and patients' experiences of their health care. 

The United Arab Emirates has one of the the highest prevalences of diabetes in the world. Improving the care of people with Type  2 diabetes is therefore a priority for its health system. In a paper published in JRSM Short Reports , Layla Alhyas and colleagues aimed to identify facilitators of and barriers to healthcare professionals' motivation in a specialist diabetes centre. A qualitative research approach was employed using semi-structured interviews to assess perceptions and attitudes regarding healthcare professionals' motivation in providing good quality diabetes care. The participants included specialist physicians, dieticians, podiatrists, health educators and nurses. Important facilitators and barriers related to patient, professional, organization and cultural factors were identified. Barriers that related to heavy workload, disjointed care, lack of patient compliance and awareness, and cultural beliefs and attitudes about diabetes were common. Key facilitators in...

Over the course of 2013-14, a new national vaccination programme for Rotavirus will be introduced for babies. The vaccine (Rotarix) will be given to babies at two months of age, followed by a second dose at three months of age. Rotavirus is a virus that causes gastroenteritis, leading to diarrhoea and vomiting, in particular in infants and young children. Almost all children have had a Rotavirus infection by the time they are 5 years old, with the maximum risk of infection occurring at around one year of age. Many children with Rotavirus infection will be managed by their parents without needing medical treatment but around 130,000 children will see their general practitioner each year because of Rotavirus infection and around 12,700 children will be admitted to hospital. The new vaccination programme should substantially reduce both the number of children infected with Rotavirus and the number of children admitted to hospital each year. Early studies suggest that the vacci...

Multidisciplinary Group Meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. In an article published in the International Journal of Integrated Care , Matthew Harris and colleagues describe the development of a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. Harris and colleagues defined ‘integrating’ as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from ...