Does products liability litigation threaten picture archiving and communication systems and/or telemedicine?

Numerous writers have commented on barriers to the growth and progress of telemedicine. Among these barriers are reimbursement concerns, professional liability exposure, licensing restrictions, hospital credentialing questions, and other problems. A legal threat not generally described in the literature to date is the possibility that products liability claims could be brought against manufacturers and distributors of hardware, software, and peripherals used in providing telemedicine services. Several of these concerns extend to picture archiving and communication systems (PACS), including, of course, teleradiology. This article considers that possibility in the context of several potential plaintiffs' theories, discusses currently applicable law, and proposes approaches to diminishing the magnitude and severity of this potential threat.

Intervention in alcohol use disorder in a general practice.

AIM: To report the outcome of intervention in 70 patients with alcohol use disorder in a general practice. METHOD: Of the 84 patients age 18-69 years identified clinically or by a screening programme with alcohol use disorder, 70 who were available for at least 2 year follow up after diagnosis were included in the study group. The clinical notes of these patients were reviewed to determine evidence of sustained achievement of abstinence or controlled drinking and factors contributing to successful change in alcohol use. RESULTS: Sustained abstinence or controlled drinking was verified for 31 patients (44%) with a further 26 patients (37%) reporting reduction in alcohol use without evidence of sustained improvement. The mean interval from diagnosis to sustained improvement was 4 years. Only five patients accepted referral to specialist alcohol units. Successful change in the 31 patients achieving their drinking goal was directly related to intervention at the surgery for 9 patients. CONCLUSION: A motivational approach with focus on the patient's perception of the issues proved relatively successful in this practice. A prolonged period of change was required to achieve drinking goals. Other factors contributing to improvement are discussed.

Detecting young adults with alcohol use disorder in a general practice.

AIM: To report the detection of alcohol use disorder in 339 general practice patients age 18-29 years over a 5 year period. METHOD: Information on alcohol use was recorded in the patient notes during clinical or screening assessment. Screening was undertaken as part of a health check which included questions on consumption, concern about use and liver function tests in selected patients. The notes of all patients in this age group were reviewed after 5 years to determine the prevalence of alcohol use disorder and the method of detection. RESULTS: Information on alcohol use was recorded for 236 patients (70%), collected at a screening check for 202 patients and clinically for 34 patients. No information was recorded for 103 patients. Alcohol use was recorded for 83% of the women predominantly in association with other screening checks (cervical smears and antenatal checks). Alcohol use was recorded for 59% of the men, most of whom were screened on an opportunistic basis when attending for a consultation or linked to a clinical follow-up appointment. The criteria for alcohol use disorder was met by 16% of the men and 6% of the women whose alcohol use had been assessed either clinically or by screening. Overall, just under half of those identified with alcohol use disorder were detected by the screening programme. CONCLUSION: Both screening and clinical detection contributed to the identification of alcohol use disorder in this age group. Women were screened more successfully than men in association with other checks. A considerable proportion of men remained unscreened and a strategy for improving detection in this group is discussed.

Screening for coronary heart disease risk among men in a general practice.

AIM: This study evaluates the effectiveness of screening men for coronary heart disease (CHD) risk during a general practice health screening programme. METHOD: Patients age 30-69 years were recruited by opportunistic invitation over 3 years into the screening programme. A self administered questionnaire was used to identify personal and family history of CHD, stroke or diabetes, smoking and alcohol use, and exercise history. Blood pressure, weight and height were recorded by the practice nurse, and laboratory measurement of serum cholesterol and fasting glucose (family history of diabetes or obese patients) arranged. CHD risk status was assessed by the doctor. RESULTS: Increased CHD risk was assessed in 24% (68) of the 284 men screened (28 high risk, 40 moderate risk). The prevalence of diagnosed hypertension increased from 11% to 18%. Serum cholesterol > 7.5 mmol/L was found in 8% (23 men), though nearly all the 68 men at increased risk would have been identified without routine cholesterol measurement. A 24% smoking cessation rate was reported among the 41 smokers in the increased risk group, with a 56% cessation rate among those at highest risk attending for regular follow up. The prevalence of an alcohol use disorder among those in the increased risk group was 34% compared with 13% among all men in this practice age group. CONCLUSION: A high screening rate was achieved by opportunistic recruitment into the screening programme with more complete assessment of CHD risk status than achieved by the previous opportunistic approach. Sufficient new findings justified the effort involved in screening. Continuing surveillance was identified as an important requirement for successful risk reduction.

Screening for alcohol use disorder in a general practice.

AIM: To report the results of screening for alcohol use disorder in 611 general practice patients aged 30-69 years over a three year period. METHOD: Patients attending a health screening appointment completed a self-administered questionnaire assessing alcohol consumption and concern about drinking, and liver function tests were arranged. Positive results were assessed and patients classified according to DSM IIIR criteria for alcohol use disorder into an alcohol abuse or dependence group. Those screening positive but not meeting criteria for alcohol use disorder were classified as at-risk drinkers. RESULTS: A positive alcohol screen was confirmed in 133 patients (22%), of whom 39 met the criteria for an alcohol use disorder, the remaining 94 classified at-risk. Weekly alcohol consumption above 20 drinks for men and 15 drinks for women identified 79% of those with an alcohol use disorder increasing to 83% by the addition of information about episodic heavy drinking. The inclusion of laboratory results improved the sensitivity of the overall alcohol screen to 93%, mostly by improving detection of alcohol abuse among men. The prevalence of alcohol use disorder among the 801 patients in this practice age group over three years was 13% for men and 2.5% for women. Half of these patients were identified only as a result of the screening programme. CONCLUSION: Screening for alcohol use disorder with items included in a health check proved very effective in this practice, identifying a significant number of previously undetected patients with alcohol abuse and dependence.

Health screening in a general practice by opportunistic recruitment.

AIMS: this study aims to assess the effectiveness of opportunistic recruitment into a general practice health screening programme and subsequent improvement in screening rates. METHODS: a study group of 754 patients aged 30-69 years (345 men, 409 women) in a Wanganui general practice were invited by the doctor when attending the surgery to return for a preventive health check. The check included a self administered screening questionnaire, selected examination items performed by the practice nurse, and a consultation with the doctor to review the findings. RESULTS: over the three year study period 327 of the men and 392 of the women attended the surgery. An invitation to return for a health check was offered to 307 men and 329 women with completion of health checks by 294 men and 317 women, resulting in a screening rate in the study group of 85% for men and 78% for women. Selected screening indicators showed improvement with blood pressure recording increasing from 48% to 85% for men, and cervical cancer screening improving from 45% to 87% for women. CONCLUSION: opportunistic recruitment by the doctor's personal invitation proved an effective approach to health screening in this practice with significant improvement in selected screening indicators.