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(2) HOME
VISITING TO OLDER PEOPLE REDUCES
DEATH RATES
AND THE NEED FOR
LONG-TERM INSTITUTIONAL
CARE
(3) NATIONAL
GUIDANCE AGENCIES DO NOT
ENHANCE THE
NHS BUT DISTORT THE
ALLOCATION
OF RESOURCES, SAY
ACADEMICS
(4) SICK
GPs FAIL TO PRACTICE WHAT THEY
PREACH
(1) GREATER VIGILANCE
NEEDED ON SAFETY
OF OVER THE COUNTER DRUGS
(Editorial: Monitoring the safety
of over the counter
drugs)
http://bmj.com/cgi/content/full/323/7315/706
It is currently rare for pharmacists to
record the details
of patients to whom they sell over the
counter medicines
but an editorial in this week's BMJ argues
that it would
be in the public health interest for pharmacists
to do so.
David Clark of the Department of Pharmacology,
University of Otago, New Zealand and Layton
and
Saad Shakir of the Drug Safety Research
Unit at
Southampton argue that consumers believe
that
non-prescription medicines are safe because
they are
freely available over the counter. However,
the trend to
self medication and the switch from prescription
only to
pharmacy only status means that more and
more
powerful medications are becoming available
over the
counter.
These products are not always used correctly,
so the
use of over the counter medicines should
be monitored
and quantifed. The authors argue that
spontaneous
reporting of adverse reactions is inadequate
and a more
rigorous system of recording by pharmacists
is now
indicated.
Contact:
Dr Saad Shakir, Director, Drug Safety Research
Unit,
Southampton, UK
Email : saad.shakir@dsru.org
(2) HOME VISITING
TO OLDER PEOPLE REDUCES
DEATH RATES AND THE NEED FOR
LONG-TERM INSTITUTIONAL CARE
(Effectiveness of home based support
for older people:
systematic review and meta-analysis)
http://bmj.com/cgi/content/full/323/7315/719
(Commentary: When, where, and why
do preventive
home visits work?)
http://bmj.com/cgi/content/full/323/7315/719
(Editorial: Preventive home visits
to elderly people)
http://bmj.com/cgi/content/full/323/7315/708
Home visits to older people appear to reduce
their risk
of death and admission to long term institutional
care,
reports a study in this week's BMJ.
Given the shortcomings and inconsistencies
of previous
studies the research team at the University
of
Nottingham's Faculty of Medicine decided
to review
and compare the results of 15 previous
studies of home
visiting to establish whether these programmes
are
beneficial to the health of older people.
The results of the research show that by
visiting older
people in their homes and offering health
promotion and
preventive care, death rates and admission
to long-term
institutional care are significantly reduced.
However, the
research also concluded that there were
no significant
reductions in admissions to hospital.
The results of this very large study is
all the more
important given that previous smaller
research projects
have concluded that home visits to older
people should
be discontinued because they were not
effective.
Although the research did not aim to assess
the quality
of different home visiting projects, it
is clear that some
programmes were more successful than others.
The
authors suggest that what is required
is a greater focus
on the process of delivering care and
on attempting to
identify which components of home visiting
work.
Contacts:
[Paper]: Ruth Elkan, Research Fellow, School
of
Nursing, Postgraduate Division, University
of
Nottingham, UK
Email: ruth.elkan@nottingham.ac.uk
[Commentary]: Matthias Egger, Senior Lecturer
in
Clinical Epidemiology, Department of Social
Medicine,
University of Bristol, UK Email: m.egger@bristol.ac.uk
(3) NATIONAL GUIDANCE
AGENCIES DO NOT
ENHANCE THE NHS BUT DISTORT THE
ALLOCATION OF RESOURCES, SAY
ACADEMICS
(Wrong SIGN, NICE mess, is national
guidance distorting allocation of
resources?)
http://bmj.com/cgi/content/full/323/7315/743
In a report in this week's BMJ, the NHS
guidance
agencies come under fire for distorting
the allocation of
resources and not contributing to the
performance and
effectiveness of the Health Service.
The system in Scotland is criticised for
having two
competing agencies, the Scottish Intercollegiate
Guidelines Network (SIGN) and the Health
Technology Board for Scotland. And another
agency,
the Scottish Medicines Consortium is soon
to be set up.
In England and Wales one agency exists,
the National
Institute for Clinical Excellence (NICE).
The remit of the above agencies includes
ensuring that
patients receive the highest levels of
care, that postcode
rationing is reduced and that the NHS
performs as
cost-effectively as possible.
However, SIGN has not even started to consider
cost
effectiveness. NICE has done this but
is reluctant to
advise against funding many costly new
drugs. Neither
agency is up to the job of informing the
public and
government about the 'hard choices' about
the rationing
of scarce health resources.
The authors of the paper make various suggestions
to
improve the current ' muddle' and find
a way forward:
NICE should become a national healthcare
rationing
agency, with SIGN and the other Scottish
agencies
complementing this activity. NICE needs
to start saying
'no' to costly and relatively cost ineffective
new drugs
and devices. NICE should prioritise national
guidance
within a fixed growth budget for new technologies.
NICE should be given the option that national
guidance
is inappropriate for some technologies,
if reducing
postcode prescribing would compromise
other goals
relating to equity or efficiency.
All those involved in rationing health
care in the UK, be
they politicians who promise more than
can reasonably
be delivered or practitioners who deal
with such
choices in their everyday work, need to
be more
focused and explicit if this ambitious
rationing agenda is
to avoid muddle and damage to patients,
they conclude.
Contact:
Professor Alan Maynard, Director, York
Health Policy
Group, University of York, York, UK
Email: akm3@york.ac.uk
(4) SICK GPs FAIL
TO PRACTICE WHAT THEY
PREACH
(Challenge of culture, conscience,
and contract to
general practitioners' care of their
own health: qualitative
study)
http://bmj.com/cgi/content/full/323/7315/728
Family doctors - burdened with a sense
of duty of not
letting down their patients or partners
- fail to
acknowledge their own ill health and attempt
to work
through their symptoms, says a report
in this week's
BMJ.
Thompson and colleagues in Belfast studied
27
Northern Ireland GPs about the effects
of their
profession and training on their attitudes
to illness in
themselves and their colleagues.
Their report says "A sense of conscience
towards
patients and colleagues and the working
arrangements
of the practice were cited as reasons
for continuing to
work through illness and expecting colleagues
to do
likewise." They found GPs felt a need
to portray a
healthy image to both patients and colleagues.
This
hindered them from taking part in health
screening or
acknowledging personal illness.
GPs talked about the pressure to appear
physically
well. They reported a perception that
patients believed
a doctor's health somehow reflected his
or her medical
competence. Several reported that the
GPs' medical
knowledge made them prone to swing between
panic
and denial when they experienced potentially
serious
symptoms.
Family doctors were concerned about the
current level
of illness within the profession and the
report concludes
that steps must be taken to promote appropriate
care of
their own health among doctors. The authors
make a
number of recommendations in relation
to education
and occupational health support.
Contact:
Dr Margaret Cupples, Senior lecturer, Dept
of General
Practice, School of Medicine, Queen's
University,
Belfast.
Email: m.cupples@qub.ac
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