Press releases Saturday 13 March 2004

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(1) STARK DIFFERENCES IN CARE AT TOP US HOSPITALS REVEALED

(2) RANDOM DRUG TESTING IN SCHOOLS IS UNWORKABLE

(1) STARK DIFFERENCES IN CARE AT TOP US HOSPITALS REVEALED

(Use of hospitals, physician visits, and hospice care during the last six months of life among cohorts loyal to highly respected hospitals in the United States)
http://bmj.com/cgi/content/full/328/7440/607

Striking differences exist in the care provided to dying patients by top US hospitals, according to researchers in this week's BMJ. These findings prompt concerns about hospital reforms in Britain and elsewhere.

Researchers identified patients attending 77 hospitals that appeared on the 2001 US News and World Report "best hospitals" list for chronic illness and geriatric care. Use of healthcare resources by these patients during the last six months of life was measured.

The intensity of care during the last six months of life and at the time of death varied substantially, even among hospitals in the same region. Time spent in hospital ranged from less than 10 days to 27 days, and time in intensive care units ranged from less than two days to almost 10 days. The percentage of deaths occurring in hospital ranged from less than 16% to more than 55%, and the percentage of deaths associated with a stay in intensive care ranged from less than 9% to more than 36%.

Variations in end of life care among the best hospitals in the United States raise further questions about the appropriate role for acute hospital care in the management of chronically ill patients, conclude the authors.

These findings should make policy makers wary of unleashing further, often ill considered, reforms on health systems, writes Professor David Hunter in an accompanying commentary.

They also prompt concerns about whether the UK government's commitment to providing 9,500 more doctors and increasing capacity by 7,000 beds is entirely wise or appropriate if having more of them doing much the same sort of work in the same way is no guarantee of better health.

Contacts:

Paper: Professor John Wennberg, Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, USA Email: john.wennberg@Dartmouth.edu

Commentary: Professor David Hunter, Wolfson Research Institute, University of Durham, Stockton on Tees, UK
Email: d.j.hunter@durham.ac.uk

(2) RANDOM DRUG TESTING IN SCHOOLS IS UNWORKABLE

(Letter: Random drug testing in schools fails screening criteria)
http://bmj.com/cgi/content/full/328/7440/641

Random drug testing in schools is unworkable because schools could not satisfy government criteria for introducing new screening programmes, claims a public health expert in this week's BMJ.

The Department of Health has 19 criteria for introducing new screening programmes. At least 18 of these are not met for widespread drug urine analysis in schools, writes Woody Caan, Professor of Public Health at Anglia Polytechnic University.

Three failed criteria concerning investigation and treatment of people with a positive test result are especially pertinent to screening for school age drug use.

He also argues that a single, positive urine test, for any illicit drug, is probably not meaningful without examining the context in which the drug is used.

For instance, use by a homeless pregnant teenage runaway with a history of deliberate self harm may be very different from a single experimental use at home with adults during a family party, he says.

"In three years' of experience of school health provision for alcohol and drug problems and their related referral networks, I do not know of one school that could satisfy these criteria, especially the underpinning policy of promoting informed choice for children and families," he concludes.

Contact:

Woody Caan, Professor of Public Health, Department of Public and Family Health, Anglia Polytechnic University, Chelmsford, Essex, UK Available via email only (will be checking regularly): a.w.caan@apu.ac.uk

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