Medical Centre

The incorrect classification, diagnosis and coding of the type of diabetes can affect the quality of health care that people with diabetes receive. A study published recently in the journal Diabetic Medicine examined the accuracy of diagnostic data on diabetes. The study found that errors in the coding and classification of diabetes were common. The study included some useful algorithms to help doctors identify which patients may not have their diabetes recorded correctly.

An opportunity has arisen for either a Research Assistant or Research Associate to join an international/cross-discipline team creating a rapid learning healthcare system to improve patient safety and volume of clinical research in Europe. This is an exciting opportunity for an individual with a keen interest in data mining and/or data provenance who is looking to gain experience in medical informatics. The aim of the research is to design and develop an extensible provenance framework to be integrated into the decision support and data mining engines to ensure auditability and accountability. This position will be responsible for investigating existing provenance models and their applicability to data mining tasks and contributing to the development of novel data mining models for translational data. See the Imperial College Recruitment Page for further details.

I attended a conference today hosted jointly by the Imperial College’s Institute for Global Health and the Lancet which discussed public financing of health in developing countries. The centre-piece of the conference was a presentation by Professor Christopher Murray of the paper published by him and his colleagues in the Lancet . The main conclusion of Professor Murray’s study was that development assistance for health from donor countries can lead to a reduction in direct government spending on health in developing countries. In contrast, when development assistance for health was given to non-governmental organisations, this effect was not present. The study was a very impressive achievement, particularly given the limitations of the data that Professor Murray’s team had to use. The study raises some important questions for both donor countries and recipients of development assistance for health.

A recent article in Primary Care Diabetes examines the question of whether pay for performance has improved the management of diabetes in the United Kingdom. Over the past decade, the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance programme for general practices launched in April 2004. The QOF aimed to improve the primary care management of common chronic conditions including diabetes. The introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies have adjusted for underlying trends in quality. QOF may also have reduced inequalities in diabetes care between affluent and deprived areas. Less is known about the impact of QOF on aspects of diabetes care ...

The London Research Design Services will be holding a drop-in session at the Reynolds Building on Thursday March 25 2010. RDS London provides guidance and support to clinicians and academics preparing grant applications to he NIHR. The drop-in sessions are open to all, whether you just want to find out more about the service or would like to discuss a proposal with one of RDS London’s experts. There will be a number of RDS advisers available on the day that will be able to offer you advice on all aspects of your proposal.

Last week, I attended a seminar at the University of Tokyo, organised by the Todai Policy Alternatives Research Institute . I spoke about the secondary uses of data from electronic patient records in the UK (the primary use is defined as their role in providing direct clinical care). Also speaking at the conference were John Halamka from Harvard and Nikolaus Forgo from Hanover, as well as speakers from the University of Tokyo, such as Professor Morita , Professor Akiyama, and Professor Sakata. Amongst the audience of 250 were representatives from clinical medicine, academia, government and health service management. I was very impressed by the expertise and commitment to this area of work in Japan. You can view a summary of the proceedings in Japanese .

There is currently an ongoing debate in the USA about whether the US government should expand health coverage to include some groups that have limited access to health care. In the UK, we have had universal health coverage since 1948, when the NHS was introduced. The US health system has some stark disparities between ethnic groups. A recent article from Imperial College published in the Journal of Public Health examined change in the quality of care for people with diabetes over a 10 year period from 1997-2006. We found that although Although ethnic disparities persist in diabetes management, these are starting to be addressed, particularly in the South Asian group. It appears therefore that all ethnic groups have benefited from recent quality improvement initiatives in the UK.

A recent article in Informatics in Primary Care discussed how we can build on a Wellcome Trust report on the use of electronic patient records (EPRs) from general practice for research. The UK could significantly enhance its health research capability by making effective use of data from electronic patient records for secondary research. The Wellcome Trust report provides useful guidance to researchers and clinicians on why secondary research using data from electronic records in primary care is important. Combined with advances in NHS Information Technology systems, particularly the Research Capability Programme, and financial support from the NIHR, we need to make this potential a reality and ensure that the UK remains a world leader in primary care informatics.

The department hosted a visit this week by a delegation from Singapore, with help from the Lillie Road Surgery. The visit was to discuss collaboration between Singapore and Imperial College in the areas of undergraduate education and research.

A recent report from the NHS Confederation and the Royal College of Physicians examines the growing cost to the NHS of treating people with alcohol-related diseases. The report was also covered by the BBC News . One of the important complications of excessive alcohol intake is liver disease. In a paper published in 2008 in the journal Alcohol and Alcoholism , along with colleagues from St.Georges Hospital and the Office for National Statistics, I examined trends in hospital admissions and mortality in England from chronic liver disease. Hospital admission rates for chronic liver disease increased by 71% in males and 43% in females between 1989 to 2003. This increase was largely due to alcoholic liver disease, admission rates for which more than doubled between 1989/1990 and 2002/2003. Mortality rates for chronic liver disease more than doubled between 1979 and 2005 with two thirds of these deaths attributable to alcohol-related liver disease in 2005. The highest rate of alcoholic live...

Earlier this year, the Department of Primary Care & Public Health at Imperial College hosted a visit from a delegation from the Ministry of Health in the Republic of Macedonia . During the visit, academics in the department discussed the primary healthcare system in the Republic of Macedonia and ways in which the Department of Primary Care & Public Health could support both undergraduate and postgraduate training in primary care. The Republic of Macedonia faces major challenges in improving its health system and the development of high-quality primary care services is seen as a key step in achieving improved access to healthcare.

A recent article in the journal Diabetes Research and Clinical Practice examined trends in lower extremity amputations in people with and without diabetes in England during the period 1996-2005. The study, which was reported on the BBC News Website , found that although overall numbers of amputations fell, the number occurring in people with type 2 diabetes increased. This may be because the prevalence of type 2 diabetes increased over this period and because surgeons are intervening earlier to prevent more serious damage to the feet and legs of people with type 2 diabetes.

Research Design Service (RDS) London is part of the NIHR and provides help to those preparing research proposals for submission to the NIHR for applied health or social care research. With centres based at King's College London, Imperial College London , Queen Mary and University College London, it is focused on supporting applications for funding from NHS researchers and those working in partnership with the NHS. Priority is given to those applying for NIHR Research for Patient Benefit (RfPB) and Programme Grant funding. Advice is provided free of charge and is available through use of online resource and consultations with experts.

One of my professional roles is acting as Associate Director (Primary Care) for the Diabetes Research Network . Diabetes is one of the most common chronic diseases that primary care professionals treat, affecting nearly 4% of the population of England. A key aim for Diabetes Research Network will be to encourage general practitioners, practice nurses and other primary care professionals to take part in its activities and to help recruit patients for clinical trials and other studies. A recent article in the journal Primary Care Diabetes discusses how primary health care professionals and the Diabetes Research Network can work together.

A study from Imperial College , LSHTM and the University of Leicester published online in the BMJ this week compared the safety of drugs used for the treatment of type 2 diabetes. The findings of the study confirm that Metformin remains the first choice drug for the treatment of type 2 diabetes. Patients taking sulphonylureas were more likely to suffer from heart attacks and heart failure or to die, compared to people taking Metformin. Doctors should therefore consider Metformin as their first choice when treating people with type 2 diabetes, as recommended by national guidelines from NICE . The study was reported by a number of media outlets, including the Guardian , Telegraph and NHS Choices .

I gave a seminar on electronic primary care records last week on the Imperial College MPH programme, as part of the module on health information. The seminar covered the uses of data from primary care records to support public health, epidemiological, health services and clinical research. As more general practitioners use electronic primary care records, the scope for secondary uses of the data derived from them will increase. Further information is available from two of my publications on primary care data, published by the Eastern Region Public Health Observatory and in Health Statistics Quarterly .

NHS Choices is a service that aims to give patients and the public information about their health and healthcare. The service is intended to help patients and the public make decisions choices about their health, from lifestyle factors such as smoking, drinking and exercise, through to the practical aspects of finding and using NHS services in England. My practice now has a page on NHS choices , which we have now updated. In coming months, we will be aiming to make more use of the facilities available via NHS Choices to support our patients.

The Quality & Outcomes Framework (QOF) is now well established in primary care. With control of the framework now lying with the National Institute for Health & Clinical Excellence (NICE), we can expect a greater focus on the clinical effectiveness and cost effectiveness of quality indicators. In the early years of the QOF, a large proportion of target payments were awarded for achieving process measures, such as measuring blood pressure or HbA1c. Achievement of such process measures is now very high, with little room for improvement in many practices and limited potential for further health gain. By contrast, control of key risk factors, such as blood pressure in people with hypertension, or HBA1c in people with diabetes, could still be improved considerably. But changing patients' behaviour or optimising their management to achieve such improvements is difficult and imposes a considerable workload on primary care. So it is logical to consider increasing the financial in...

Information technology has great potential to improve the quality and safety of healthcare. However, this potential has not yet been fully realised and considerable work remains to be done in this field. Earlier this year, the World Health Organization held a meeting on technology and patient safety . I chaired one of the four working groups, which were comprised of members from across the world. My working group has now completed its report, which is currently undergoing peer review.

The International Educational Fund held a successful event to raise funds for their project to aid Saharawi refugee children living in Algeria. Amongst the speakers at the event were myself, Professor Alan Fenwick, Professor Sir Roy Anderson, Professor Sir Magdi Yacoub, Professor Yahia Zoubir and Ms Danielle Smith. Pictured above are Sir Roy Anderson, Alan Fenwick, Suha Bachir (the current chair of the IEF) and myself along with some of the other executive members of the IEF. Congratulations to the IEF for all the hard work they put in to make this event successful.