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(2) TARGETS
FOR PREVENTING HEART DISEASE
PUT HUGE STRAIN
ON UK GENERAL PRACTICE
(3) CAN
EMAIL HELP DOCTORS USE THEIR TIME
MORE PRODUCTIVELY?
(1) DEPRESSION
MORE COMMON DURING
PREGNANCY THAN AFTER CHILDBIRTH
(Cohort study of depressed mood during
pregnancy and
after childbirth)
http://bmj.com/cgi/content/full/323/7307/257
Depression during pregnancy is more common
than
postnatal depression, finds a study in
this week's BMJ. As
mood during pregnancy may affect the unborn
child, more
efforts need to be directed towards recognising
and
treating antenatal depression, report
the authors.
Over 9,000 pregnant women recorded their
mood through
pregnancy and after childbirth in a series
of questionnaires.
Any reported symptoms of depression were
measured
against a recognised depression scale.
Depression scores were higher during pregnancy
than after
childbirth, with a peak at 32 weeks of
pregnancy and a
lowest value 8 months after childbirth.
The severity and
nature of reported symptoms did not differ
before and
after childbirth, suggesting that depression
is no more likely
after childbirth than it is during pregnancy,
say the authors.
Although postnatal depression has become
a focus of
concern, depression during pregnancy has
been relatively
neglected, say the authors. They call
for urgent research
into both the consequences for the child
and the potential
benefits of screening for, and treating,
depression during
pregnancy. "Offering treatment may be
important for both
the mother and the future wellbeing of
the child and
family," they conclude.
Contact:
Jonathan Evans, Consultant Senior Lecturer,
Division of
Psychiatry, University of Bristol, Bristol,
UK
Email: j.evans@bristol.ac.uk
(2) TARGETS FOR
PREVENTING HEART DISEASE
PUT HUGE STRAIN ON UK GENERAL PRACTICE
(General practice workload implications
of the national
service framework for coronary heart
disease: cross
sectional survey)
http://bmj.com/cgi/content/full/323/7307/269
(Editorial: Preventing cardiovascular
disease in primary
care)
http://bmj.com/cgi/content/full/323/7307/246
Primary care teams in England face a huge
and unrealistic
increase in workload in order to meet
the goals of the
national service framework for coronary
heart disease,
finds a study in this week's BMJ.
Researchers at Nottingham University used
computerised
records from 18 general practices to identify
two groups
of patients aged 35-74: those with established
coronary
heart disease or stroke and those at high
risk of developing
coronary heart disease.
Based on the list of standards described
in the framework,
the team estimated that in the average
practice of 10,000
patients, over 900 items will need recording
and over
2,000 disease control measures will be
needed, with
profound implications for primary care,
say the authors.
Furthermore, study limitations mean that
these estimates
are conservative, they add.
In an accompanying editorial, two leading
experts in
general practice ask: "In the absence
of additional
resources, how should this extra work
be prioritised
alongside everything else required of
primary care?" They
discuss the challenges involved in identifying
and delivering
effective preventative strategies given
a global shortage of
doctors and nurses, and question whether
the workload
involved in meeting these expectations
is matched by the
benefits gained.
With more national service frameworks promised,
those
seeking accountability from the health
service should
acknowledge the current workload, morale,
and
opportunity costs of their targets and
timeframes, conclude
the authors.
Contacts:
[Paper]:Julia Hippisley-Cox, Senior Lecturer
in General
Practice, Nottingham University, Nottingham,
UK
Email: julia.hippisley-cox@nottingham.ac.uk
[Editorial]: Les Toop, Professor of General
Practice,
Christchurch School of Medicine and Health
Sciences,
University of Otago, Christchurch, New
Zealand
Email: les.toop@chmeds.ac.nz
(3) CAN EMAIL
HELP DOCTORS USE THEIR TIME
MORE PRODUCTIVELY?
(How should hamsters run? Some observations
about
sufficient patient time in primary
care)
http://bmj.com/cgi/content/full/323/7307/266
In almost every era doctors have perceived
themselves as
"running faster" but there is little evidence
to support this.
Doctors feel stressed because there is
now so much more
they can do. There are more external forces
impinging on
their practice and patients and the public
have raised
expectations, yet patients value meaningful
time with a
trusted clinician.
A paper in this week's BMJ explores how
new
technologies can help doctors maintain
continuity of care
and allow more time for meaningful communication
with
patients.
Some doctors think that email will increase
practice
demands and not substitute for other care,
writes David
Mechanic, a Research Institute Director
at the State
University of New Jersey. However, primary
care doctors
who have adopted email with patients report
favourable
results.
Email is also a way for patients to maintain
continuity with
their doctors, explains the author. It
can facilitate
information flow, allow better scheduling
of appointments,
and avoid gaps in communication. It may
also reduce
unnecessary appointments, save the patient
and doctor
time and inconvenience, and contribute
to health education
and patient responsibility.
Email communication with patients, properly
structured
and with adequate safeguards, helps maintain
continuity of
care, provides opportunities to deal with
routine matters,
and allows more time for meaningful communication,
he
concludes.
Contact:
David Mechanic, Director, Institute for
Health, Health
Care Policy and Ageing Research, Rutgers,
the State
University of New Jersey, New Brunswick,
NJ, USA
Email: mechanic@rci.rutgers.edu
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