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(2) WOMEN
WITH MULTIPLE SCLEROSIS AND LOW
MOBILITY RECEIVE
LESS PREVENTIVE
SERVICES
(3) IMPROVED
CARE NEEDED FOR POEPLE WITH
DEPRESSION
(4) A
PERSONAL APPROACH CAN ENHANCE
DIABETES CARE
(1) ACTION NEEDED
TO REDUCE HOSPITAL
ADMISSION FOR ASTHMA IN SOUTH ASIAN
GROUPS
(Influences on hospital admission
for asthma in south
Asian and white adults: qualitative
interview study)
http://bmj.com/cgi/content/full/323/7319/962
Black and South Asian people with asthma
are at
increased risk of hospital admission from
acute attacks
than white patients. Researchers in this
week's BMJ find
that different ways of coping with asthma
among this
group may act as barriers to good care,
and they suggest
ways in which such barriers can be overcome
and
admission rates reduced.
In collaboration with general practices
in east London,
researchers based at the University of
London
interviewed 58 south Asian and white adults
with asthma
(49 admitted to hospital with asthma,
9 not admitted) and
25 health professionals about influences
on hospital
admission.
They found that south Asian patients admitted
to hospital
with asthma had less confidence in controlling
their
asthma, were unfamiliar with the concept
of preventive
medication, and often expressed less confidence
in their
general practitioners than white patients.
Furthermore,
patients reporting difficulty in accessing
primary care
during asthma attacks were often south
Asian.
These findings could reflect either specific
cultural
characteristics or the difficulties of
coping with asthma in
deprived social circumstances where racism
is common
and health services are often inadequate
and
inappropriate, say the authors.
Interventions that increase confidence
to control asthma,
confidence in the general practitioner,
understanding of
preventive treatment, and use of appropriate
medication
during asthma attacks may reduce hospital
admissions,
say the authors. Development of more sophisticated
and
culturally competent asthma strategies
by general
practices with better access and partnerships
with
patients may also achieve this, they conclude.
Contacts:
[Wed 24th ± Thurs 25th October] Gene Feder,
Professor
of Primary Care Research and Development,
Queen
Mary's School of Medicine and Dentistry,
London, UK
[from Thurs 25th October] Chris Griffiths,
Reader in
Primary Care, Queen Mary's School of Medicine
and
Dentistry, London, UK
Email: c.j.griffiths@mds.qmw.ac.uk
(2) WOMEN WITH
MULTIPLE SCLEROSIS AND LOW
MOBILITY RECEIVE LESS PREVENTIVE
SERVICES
(Mobility impairments and use of
preventive services in
women with multiple sclerosis: observational
study)
http://bmj.com/cgi/content/full/323/7319/968
(Editorial: Meeting the needs of
the chronically ill)
http://bmj.com/cgi/content/full/323/7319/945
Women with multiple sclerosis and considerable
disability
are less likely to receive appropriate
preventive care than
those with less disability, despite their
undiminished life
expectancy, concludes a study in this
week's BMJ.
Researchers in the United States collected
self-reported
rates of preventive care (such as cervical
smear testing,
mammography, blood pressure checks and
cholesterol
screening) for 713 women with multiple
sclerosis. They
assessed these rates according to the
patient's mobility
level and compared them with Healthy People
2000
recommendations.
Although rates for general preventive services
did not
differ by mobility, women with severe
mobility
impairments were almost five times as
likely not to have
a cervical smear test, three times as
likely not to have a
breast examination, and three times as
likely not to have
mammography compared to fully mobile women.
There are several possible explanations
for these
findings, say the authors. For instance,
patients may be
reluctant to undergo screening services
that are
potentially uncomfortable and embarrassing.
Alternatively, the medical systems cannot
easily
accommodate patients with mobility impairments,
who
may require access to specialised equipment
and extra
time.
Women with impaired mobility should be
considered a
vulnerable population for receipt of breast
examinations,
mammography and cervical smear tests,
say the authors.
Studies are needed to identify factors
causing this and to
evaluate interventions to reduce the variation
across
mobility levels, they conclude.
Contact:
Paper: Eric Cheng, Health Services Fellow,
University of
California, Los Angeles, USA.
Email: emc@ucla.edu
(3) IMPROVED CARE
NEEDED FOR POEPLE WITH
DEPRESSION
(Editorial: Improving outcomes in
depression: the whole
process of care needs to be enhanced)
http://bmj.com/cgi/content/full/323/7319/948
Around 450 million people worldwide have
mental or
psychosocial problems, but up to a quarter
of those who
turn to health services for help will
not be correctly
diagnosed and will not, therefore, get
the right treatment.
The whole process of care for people with
major
depression must be enhanced if we are
to improve the
lives of these patients, argue Michael
Von Korff and
David Goldberg in this week's BMJ. Research
shows
that enhanced care reduces symptoms and
disability, that
it is more cost-effective than usual care,
and that the
costs of improving care are modest per
case treated.
Yet change is hard work for overtaxed health
care
teams, and many might be tempted to adopt
quick and
easy quality improvement strategies that
do not usually
work, they write.
Instead, the evidence suggests that efforts
to improve the
primary care of major depression should
focus on low
cost case management together with a fluid
and
accessible working relationship among
the primary care
doctor, the case manager, and a mental
health specialist.
This model allows most depressed patients
to access
effective treatment in primary care, while
the minority
needing ongoing specialist care can be
identified and
referred more reliably.
Enhanced care for people with depression
will go a long
way towards improving the lives of these
patients, they
say. But the large gap in the quality
of care cannot be
closed only by the increased efforts of
individual
practitioners who are already overburdened,
with many
frustrated and demoralised.
The question now is whether insurers and
organisations
that provide patient care will act on
the scientific
evidence to benefit the millions of people
worldwide who
are afflicted by major depression, they
conclude.
Contacts:
Michael Von Korff, Senior Investigator,
Group Health
Cooperative, Seattle, USA
Email: Vonkorff.m@ghc.org
David Goldberg, Professor Emeritus, Institute
of
Psychiatry, King's College, London, UK
Email: d.goldberg@iop.kcl.ac.uk
(4) A PERSONAL
APPROACH CAN ENHANCE
DIABETES CARE
(Randomised controlled trial of structured
personal care
of type 2 diabetes mellitus)
http://bmj.com/cgi/content/full/323/7319/970
(Editorial: The management of diabetes)
http://bmj.com/cgi/content/full/323/7319/946
Evidence is increasing that good control
of diabetes may
postpone the development of diabetic complications,
but
maintaining good control over a long period
can be
difficult.
In this week's BMJ, Danish researchers
show that
individualised personal care, with education
and
surveillance support for general practitioners,
may bring
risk factors of patients with type 2 diabetes
to a level that
has been shown to reduce diabetic complications
for at
least six years.
A total of 874 patients with diabetes and
474 general
practitioners took part in the study.
Patients were
allocated to two groups. The structured
care group
received planned, quarterly consultations,
which enabled
them and their doctors to set treatment
goals aimed at
reducing cardiovascular risk factors.
The comparison
group received routine care from their
doctor.
The results show that, even in a group
of motivated,
volunteering general practitioners that
were already
supplying acceptable basic patient care,
a structured
personal care strategy, focusing on individual
goals and
educational and surveillance support,
can provide extra
benefit for patients with type 2 diabetes
for at least six
years.
Such schemes may reduce risk factors to
a level that has
been shown to have a beneficial effect
on the
development of diabetic complications
without adverse
weight gain, they conclude.
Contacts:
Paper: Niels de Fine Olivarius, Associate
Professor,
University of Copenhagen, Denmark
Email: no@gpract.ku.dk
Editorial: Simon Griffin, GP/University
Lecturer,
University of Cambridge, UK
Email: sjg49@medschl.cam.ac.uk
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