Releases Saturday 15 March 2003
No 7389 Volume 326
Please remember to credit the BMJ as source when publicising
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(1) ELDERLY CARE IS INADEQUATE, ESPECIALLY
IN NURSING HOMES
(2) NICE
GUIDANCE MUST BE APPLIED MORE
EFFECTIVELY
(3) GUIDELINES
ON IMPOTENCE TREATMENT DO
NOT MEET MEN'S
NEEDS
(1) ELDERLY CARE
IS INADEQUATE, ESPECIALLY
IN NURSING HOMES
(Quality of care for elderly residents
in nursing homes
and elderly people living at home:
controlled
observational study)
http://bmj.com/cgi/content/full/326/7389/580
The quality of medical care that elderly
patients receive,
particularly those in nursing homes, is
inadequate,
concludes researchers in this week's BMJ.
The study looked at 698 elderly individuals
in Bristol, of
whom 172 were residents in nursing homes
and 526
were living at home. All were aged 65
years or over.
The quality of care given to both groups
was measured
against recognised quality indicators.
The overall standard of care was inadequate
when
judged against the quality indicators,
irrespective of
where patients lived. Those living in
nursing homes
received poorer care than those living
at home, say the
authors.
Inadequate care took several different
forms: insufficient
use of beneficial drugs, poor monitoring
of chronic
diseases such as heart disease and diabetes,
and overuse
of inappropriate or unnecessary drugs.
For example,
nursing home residents were almost three
times as likely
to receive a laxative as those living
at home.
Although the study was undertaken in one
city, the
results may reflect the situation in the
UK as a whole, say
the authors. More co-ordinated care for
elderly patients
is needed to avoid these problems, they
conclude.
Contact:
Jenny Marra, Press Office, University of
Dundee,
Dundee, Scotland
Email: j.m.marra{at}dundee.ac.uk
(2) NICE GUIDANCE
MUST BE APPLIED MORE
EFFECTIVELY
(Impact of NICE guidance on laparoscopic
surgery for
inguinal hernias: analysis of interrupted
time series)
http://bmj.com/cgi/content/full/326/7389/578
Guidance from the National Institute for
Clinical
Excellence (NICE) must be implemented
more
effectively to improve NHS practice, suggest
researchers
in this week's BMJ.
They describe patterns of surgical repair
for hernias
before and after NICE guidance that recommended
the
open mesh technique over laparoscopic
repair. They
also assessed the impact of NICE's guidance.
They found that the NICE guidance had no
impact on
practice during the first year after publication,
nor did it
achieve the desired change in clinical
practice.
Laparoscopic repair of hernias is a small
part of NHS
practice, but if our findings are applicable
to other areas
on which NICE has published guidance,
NICE needs
more active dissemination and implementation
procedures, say the authors.
Their analysis shows that routinely collected
data can be
used in clinical governance. Chief executives
and medical
directors of trust hospitals have access
to hospital
episode statistics and could use these
data to monitor
implementation of guidance as part of
clinical
governance.
To improve evidence based practice in the
NHS,
guidance must be implemented more efficiently
and
clinical practice should be reviewed and
monitored using
well validated data, they conclude.
Contact:
Karen Bloor, Senior Research Fellow, Department
of
Health Sciences, University of York, York,
UK
Email: keb3{at}york.ac.uk
(3) GUIDELINES
ON IMPOTENCE TREATMENT DO
NOT MEET MEN'S NEEDS
(Letter: Erectile dysfunction: NHS
should meet current
need before preventing future medical
needs)
http://bmj.com/cgi/content/full/326/7389/598
Department of Health guidelines on drug
treatment for
impotence are not meeting the sexual needs
of many
British men, argue researchers in a letter
to this week's
BMJ.
In 1998, rationing of all drug treatments
for impotence
was introduced in the British NHS. The
Department of
Health used survey data on the frequency
of sexual
activity to recommend that one treatment
a week should
be offered on the NHS.
To examine the robustness between the Department
of
Health's recommendation and the survey
data, Brian
Hurwitz and colleagues divided 4,624 married
or
cohabiting men aged 20-59 years in the
dataset into
those whose sexual needs would or would
not be met by
one treatment per week.
They found that one treatment a week leaves
a distance
between the relevant population norm and
that offered
by the NHS: 44% of men aged 40-59 and
55% aged
40-44 years have a pattern of sexual activity
not met by
the government's recommendation.
In the interests of transparency and justice,
guidance
concerning frequency of impotence treatments
to be
offered on the NHS should refer clinicians
to age related
average frequencies of sexual intercourse,
rather than
recommending one treatment frequency for
all, they
conclude.
Contact:
Adrian Cook, Statistician, Department of
Primary Health
Care and General Practice, Faculty of
Medicine,
Imperial College of Science, Technology
and Medicine,
London, UK
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)
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