There is good agreement about the sort of care that people with multimorbidity need. But can it be delivered in the busy setting of general practice, and does it improve outcomes? In this blog we discuss the results of the 3D trial, the largest study of an intervention for multimorbidity published to date.
Managing multimorbidity is a litmus test for modern health care systems. Patients with many long-term conditions face major challenges in managing their conditions and need significant support, which means that these patients are often associated with high costs.
Despite the complexity of caring for these patients, there is also significant agreement about what sort of care they need. Many authors have highlighted that patient-centred care is crucial, … Read more
Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a cost of over £9 billion. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.
The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment.
The UK Department of Health advises that the frequency of repeat prescriptions should “balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety”.
However, it does not recommend a specific time period. As a result, local health service commissioners have developed their own guidance, with many encouraging GPs to issue short-term supplies of repeat medications, typically 28 days in length. This is supported by … Read more
As winter continues, so does the usual soul searching about the state of the UK’s National Health Service (NHS). Images of ambulances backing up outside emergency departments and patients lying on trolleys in corridors haunt politicians and the public alike.
Demand on the NHS, which is always high, increases over the coldest of seasons, when threats to health are greatest. Generally, more than 20,000 extra deaths occur from December to March than in any other four-month period in England and Wales. That number varies considerably, however – from 17,460 in 2013-4 to 43,850 in 2014-5 (which was not even a particularly cold winter). And there has been no evidence of a decreasing trend since the early 1990s, despite the national flu immunisation programme.
The percentage increase in deaths seen each winter in England and Wales … Read more
“How important are informal supporters of women experiencing domestic violence?”: “Very” – a simple answer to a complicated question. The bottom line, in terms of statistics, is that if survivors disclose their situation to anyone, it will most likely be to informal supporters (friends, relatives, neighbours and colleagues) rather than professionals.1 And this is true across the world, with research indicating that sometimes a disclosure to an informal supporter happens alongside a disclosure to a professional, but frequently this is not the case.2-5 In addition, it is not unusual for informal supporters to witness abusive behaviours, but commonly they are uncertain about what exactly it is that they are seeing, in particular, what it means, and what their role in the situation should be.6 ,7
Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.
At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.
The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.
However, if a doctor provides copies of medical records, even with the knowledge that … Read more
For 25 years, I have been a frustrated researcher. Like many, I came into the field of research to make a difference. But as the years passed, I realised that research had little influence on healthcare policy making or practice. I wanted to do something, so in 2009 I applied for a NIHR post-doctoral fellowship to skill up research teams to make a bigger impact. The feedback on my (unsuccessful) application was that researchers just had to publish in the BMJ and things would change (if only!).
Imagine my delight when a few short years later, the NIHR Knowledge Mobilisation Research Fellowship scheme was launched. Its aim was to create a “cadre of knowledge mobilisers”, proficient both in the practice and research of knowledge mobilisation (or ways of sharing knowledge). In 2014, I became one of them.
I have a problem with gambling. There’s not enough of it.
That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.
The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling … Read more
I have been a researcher for over two decades. In that time, lamentations about the limited influence of research evidence have grown. But I think we researchers are largely to blame. We steadfastly insist on disseminating our knowledge in ways that we know don’t work.
Researchers usually write scientific papers, because publication is a key career performance metric. But scientific papers are read and digested by other scientists, not those who can act on our findings. Our ethnographic study showed how and why research doesn’t reach policymakers, like healthcare commissioners.
We found that local healthcare commissioners cannot retrieve papers from many scientific journals, as they often do not have passwords or subscriptions. Although open access publication helps, commissioners usually use Google, where scientific papers often do not appear – even if open access. If a … Read more
Domestic violence is a violation of human rights with damaging social, economic and health consequences. It is any incident of controlling, coercive, threatening behaviour, violence or abuse. That abuse can be psychological, emotional, physical, sexual and financial.
The “domestic” element refers to abuse between people aged 16 or over who are, or have been, intimate partners or family members, regardless of gender or sexuality. Men, women or transgender people in straight, gay or lesbian relationships can perpetrate or experience it. So does this mean domestic violence is gender neutral? Is gender irrelevant to prevention efforts and to responding to survivors’ needs? We do not think so.