Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
2.
Br J Gen Pract ; 70(690): 8-9, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31879289
3.
Nurs Manag (Harrow) ; 26(3): 27-35, 2019 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-31468839

RESUMEN

Digital healthcare provision in England has been driven mainly by a 'top-down' approach and a focus on digital infrastructure rather than front-line delivery. This has laid the foundation, but digital care delivery still has a long way to go. This article describes an action learning programme to create digitally ready nurses. The programme, which underpins action six of NHS England's ten-point plan for general practice nursing, shows that a 'ground-up' approach to upskill and empower front-line clinicians is central to embedding technology-enabled care services (TECS). Following completion of the action learning sets (ALSs), 24 general practice nursing digital champions across Staffordshire have used TECS to deliver a range of benefits for their practice teams. This has informed the introduction and extension of the programme, with national funding for a further 12 regional pilot ALSs across England in 2018-19. Importantly, the active learning individualised approach provides a digitally ready workforce with the ability and support to adopt TECS in areas of clinical need. This ability is central to the next stage in the digital transformation of healthcare.


Asunto(s)
Medicina General/organización & administración , Personal de Enfermería/educación , Telemedicina/organización & administración , Inglaterra , Humanos , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Personal de Enfermería/psicología , Aprendizaje Basado en Problemas , Medicina Estatal
4.
Nurs Manag (Harrow) ; 2019 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-31468906

RESUMEN

Digital healthcare provision in England has been driven mainly by a 'top-down' approach and a focus on digital infrastructure rather than front-line delivery. This has laid the foundation, but digital care delivery still has a long way to go. This article describes an action learning programme to create digitally ready nurses. The programme, which underpins action six of NHS England's ten-point plan for general practice nursing, shows that a 'ground-up' approach to upskill and empower front-line clinicians is central to embedding technology-enabled care services (TECS). Following completion of the action learning sets (ALSs), 24 general practice nursing digital champions across Staffordshire have used TECS to deliver a range of benefits for their practice teams. This has informed the introduction and extension of the programme, with national funding for a further 12 regional pilot ALSs across England in 2018-19. Importantly, the active learning individualised approach provides a digitally ready workforce with the ability and support to adopt TECS in areas of clinical need. This ability is central to the next stage in the digital transformation of healthcare.

5.
BMC Fam Pract ; 20(1): 11, 2019 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-30642267

RESUMEN

BACKGROUND: NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. METHODS: RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12-18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). DISCUSSION: This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed. TRIAL REGISTRATION: ISRCTN ISRCTN10443908 . Registered 7th February 2017.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Comunicación , Relaciones Médico-Paciente , Medición de Riesgo/métodos , Inglaterra/epidemiología , Medicina General , Humanos , Investigación Cualitativa , Riesgo , Conducta de Reducción del Riesgo , Medicina Estatal
6.
Fam Pract ; 36(5): 607-613, 2019 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-30576438

RESUMEN

BACKGROUND: The evidence that large pay-for-performance schemes improve the health of populations is mixed-evidence regarding locally implemented schemes is limited. OBJECTIVE: This study evaluates the effects in Stoke-on-Trent of a local, multifaceted Quality Improvement Framework including pay for performance in general practice introduced in 2009 in the context of the national Quality and Outcomes Framework that operated from 2004. METHODS: We compared age-standardized mortality data from all 326 local authorities in England with the rates in Stoke-on-Trent using Difference-in-Differences, estimating a fixed-effects linear regression model with an interaction effect. RESULTS: In addition to the existing downward trend in cardiovascular deaths, we find an additional annual reduction of 36 deaths compared with the national mean for coronary heart disease and 13 deaths per 100000 from stroke in Stoke-on-Trent. Compared with the national mean, there was an additional reduction of 9 deaths per 100000 people per annum for coronary heart disease and 14 deaths per 100000 people per annum for stroke following the introduction of the 2009 Stoke-on-Trent Quality Improvement Framework. CONCLUSION: There are concerns about the unintended consequences of large pay-for-performance schemes in health care, but in a population with a high prevalence of disease, they may at least initially be beneficial. This study also provides evidence that a local, additional scheme may further improve the health of populations. Such schemes, whether national or local, require periodic review to evaluate the balance of their benefits and risks.

7.
BJGP Open ; 1(4): bjgpopen17X101181, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30564688

RESUMEN

Background: Social media has been utilised in a variety of healthcare settings. While its potential for extending healthcare services is recognised by the NHS, potential pitfalls exist. The place, benefits and practical problems of using Facebook in general practice are unclear. Aim: To understand the utilisation of Facebook by general practices, whether Facebook provides novel insights when compared to other centrally-hosted feedback platforms, and the prevalence of unofficial Facebook pages. Design & setting: Eighty-three general practices in North Staffordshire. Method: Publicly available information and feedback relating to general practices on official and unofficial Facebook sites was examined and compared to other, centrally-hosted feedback platforms (NHS Choices and Patient Satisfaction ratings). Thematic and descriptive analyses were undertaken to understand the nature of the content. Results: Thirty-one practices had publicly-accessible, practice-owned, official Facebook sites which, overall, had received over 7000 likes. Two had integrated booking systems, 14 allowed reviews and all had accurate practice information. Most remaining practices (41/52) were found to have an unofficial Facebook page. Conclusion: General practice use of open Facebook pages is variable, but most commonly used to provide generic practice information and for gaining patient feedback. Patient engagement with pages suggests demand for this technology. Risks associated with unmoderated unofficial pages can be mitigated by practices having official pages hosted by the practice with appropriate protocols in place for managing them. Practices need to be supported to better understand meaningful uses of this technology and the potential risks of unofficial practice Facebook pages.

9.
BMJ Open ; 7(9): e015278, 2017 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-28963282

RESUMEN

OBJECTIVES: To evaluate the feasibility and potential clinical benefits of medicines optimisation through comprehensive geriatric assessment (CGA) of frail patients with multiple conditions, by secondary care geriatricians in a general practice care setting. METHODS: Seven general practitioner (GP) practices in one region of Stoke-on-Trent volunteered to take part. GPs selected patients (n=186) who were local permanent residents, at least 65 years old and on eight or more medications per day. Patients were sent a written invitation outlining the assessment purpose/format. Prior to patient assessments, primary care staff prepared packs detailing patient medical history, recent consultations, current medications, recent laboratory tests and social circumstances. One hour was allocated for the CGA per patient, with one of three geriatricians, to enable sufficient time to explore all relevant aspects. Assessment comprised a full history, thorough clinical examination, assessment of balance and mobility, mental function and information on home environment and support arrangements. After consultation, geriatricians made recommendations regarding further assessments, investigations or medication changes. Geriatricians entered their main findings and recommendations onto a standard template. RESULTS: In total, 687 recommendations for changes in patients' medication regimens were made for 169 (91%) patients. In 17 (9%) patients there was no recommendation to alter medications. This resulted in an average of four alterations in medication per patient. The predominant changes to medications were to stop medications (34%) or to reduce the dosage (24%). Starting a new medication represented 18% of all the medication changes. Adherence rates to geriatrician medication recommendations were 72% at 6 months and 65% at 12 months. CONCLUSIONS: CGA of older patients with complex needs, by geriatricians in a general practice care setting, is feasible. Our study demonstrated constructive collaboration between GPs and geriatricians from secondary care, suggesting further studies and clinical trials are feasible and have scope to yield beneficial outcomes.


Asunto(s)
Anciano Frágil/estadística & datos numéricos , Evaluación Geriátrica/métodos , Administración del Tratamiento Farmacológico/organización & administración , Polifarmacia , Anciano , Anciano de 80 o más Años , Inglaterra , Estudios de Factibilidad , Femenino , Medicina General , Geriatría/métodos , Humanos , Masculino , Cumplimiento de la Medicación , Atención Secundaria de Salud
10.
BMJ Open ; 6(1): e010081, 2016 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-26781508

RESUMEN

OBJECTIVE: To determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol. METHODS: Stages 1 and 2 of the study deployed eight and four medical students, respectively, to undertake a mystery shopper style investigation. Stage 1: eight medical students attempted to buy ≥ 96 tablets/capsules aspirin or paracetamol in one transaction in 62 shops. Stage 2: four medical students attempted to purchase 32 paracetamol 500 mg along with a 'flu remedy preparation also containing paracetamol, in 54 shops. RESULTS: Stage 1 data revealed that 58% and 57% retailers sold more than the MHRA guidelines recommended for paracetamol and aspirin, respectively. We observed that 23% and 28% retailers were willing to sell ≥ 96 tablets of paracetamol or aspirin with no questions asked. Stage 2 results showed that 57% retailers sold 32 × 500 mg paracetamol in conjunction with a paracetamol-containing 'flu preparation; while 98% shops sold 16 × paracetamol 500 mg along with a paracetamol-containing 'flu remedy, with no questions asked of the shopper or advice given. DISCUSSION: MHRA national guidelines for OTC medicines sales appear to be poorly adhered to in non-pharmacy shops. Sales of aspirin and paracetamol OTC must be better regulated in the UK to ultimately reduce morbidity and mortality rates of deliberate and accidental overdoses.


Asunto(s)
Acetaminofén/provisión & distribución , Analgésicos no Narcóticos/provisión & distribución , Antiinflamatorios no Esteroideos/provisión & distribución , Aspirina/provisión & distribución , Adhesión a Directriz , Comercio/normas , Servicios Comunitarios de Farmacia/legislación & jurisprudencia , Servicios Comunitarios de Farmacia/normas , Embalaje de Medicamentos , Inglaterra , Humanos , Legislación de Medicamentos , Medicamentos sin Prescripción/provisión & distribución
11.
BMC Fam Pract ; 16: 83, 2015 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-26183439

RESUMEN

BACKGROUND: Hypertension is common and conveys significant risk of morbidity and mortality. However, inadequate control of hypertension is common. Following a successful local use of a simple telehealth intervention ('Florence') for the diagnosis and management of hypertension, the Advice & Interactive Messaging (AIM) for Health simple telehealth programme was launched across England in March 2013. Four protocols were developed to diagnose and monitor blood pressure (BP). The aim of this service evaluation was to identify the extent to which predefined service outcomes, regarding ascertainment of a diagnosis of hypertension, and achievement of hypertension control, were met for the hypertension protocols. METHODS: Patients with opportunistic raised BP in general practice or diagnosed hypertension were selected by their usual primary care providers to register onto diagnostic or monitoring hypertension protocols, respectively. Florence sent patients prompts via text messaging to submit readings, educational messages and user satisfaction questions. Patient responses were stored on Florence for review by their primary care health providers. This service evaluation used data from 2963 patients from general practices across England registered onto one of four AIM hypertension protocols from inception to January 2014. Data were extracted from Florence and underwent descriptive analysis. RESULTS: 1166/1468 (79 %) patients were eligible to have a diagnosis of hypertension confirmed/refuted, of which 740 (63 %) had a mean BP in the hypertensive range from one week's readings. BP control was achieved by only 5-22 % of 1495 patients signed up to one of the three monitoring protocols. Patient engagement with the monitoring protocols was initially good but reduced over time. CONCLUSIONS: Although simple telehealth may be an acceptable tool for diagnosing and monitoring hypertension among responding patient users, and can have a useful role in diagnosis of hypertension (particularly if ambulatory blood pressure monitoring (ABPM) is not possible or is declined), problems were identified. Reduced patient engagement over longer periods and acceptance of suboptimal BP control among patients on monitoring protocols need to be urgently addressed. Empirical work is required to identify barriers to achieving BP control among hypertensive patients using simple telehealth and, consequently, services be developed to address these issues.


Asunto(s)
Medicina General/métodos , Hipertensión , Telemedicina/métodos , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial/métodos , Protocolos Clínicos , Inglaterra , Medicina General/organización & administración , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Aceptación de la Atención de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Telemedicina/organización & administración
12.
BMJ Open ; 5(3): e007270, 2015 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-25795698

RESUMEN

OBJECTIVES: To establish patient and professional user satisfaction with the Advice & Interactive Messaging (AIM) for Health programme delivered using a mobile phone-based, simple telehealth intervention, 'Florence'. DESIGN: A service evaluation using data extracted from Florence and from a professional user electronic survey. SETTING: 425 primary care practices across 31 Clinical Commissioning Groups in England. PARTICIPANTS: 3381 patients registered on 1 of 10 AIM protocols between March 2013 and January 2014 and 77 professional users. INTERVENTION: The AIM programme offered 10 clinical protocols, in three broad groups: (1) hypertension diagnosis/monitoring, (2) medication reminders and (3) smoking cessation. Florence sent patients prompts to submit clinical information, educational messages and user satisfaction questions. Patient responses were reviewed by their primary healthcare providers. PRIMARY OUTCOME MEASURES: Patients and professional user experiences of using AIM, and within this, Florence. RESULTS: Patient activity using Florence was generally good at month 1 for the hypertension protocols (71-80%), but reduced over 2-3 months (31-60%). For the other protocols, patient activity was 0-39% at 3 months. Minimum target days of texting were met for half the hypertension protocols. 1707/2304 (74%) patients sent evaluative texts responded at least once. Among responders, agreement with the adapted friends and family statement generally exceeded preproject aspirations. Professional responders were generally positive or equivocal about the programme. CONCLUSIONS: Satisfaction with AIM appeared optimal when patients were carefully selected for the protocol; professional users were familiar with the system, the programme addressed a problem with the previous service delivery that was identified by users and users took an active approach to achieve clinical goals. However, there was a significant decrease in patients' use of Florence over time. Future applications may be optimised by identifying and addressing reasons for the waning use of the service and enhancing support during implementation of the service.


Asunto(s)
Actitud del Personal de Salud , Cumplimiento de la Medicación , Satisfacción del Paciente , Sistemas Recordatorios , Telemedicina , Mensaje de Texto , Asma/tratamiento farmacológico , Inglaterra , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Evaluación de Programas y Proyectos de Salud , Autocuidado , Cese del Hábito de Fumar/métodos
13.
Practitioner ; 258(1773): 29-31, 3, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25211791

RESUMEN

In England there has been a sharp increase in the prevalence of overweight and obesity in adults. In 1993 58% of men and 49% of women were classified as overweight or obese compared with 65% and 58% respectively in 2011; 24% of men and 26% of women were classed as obese in 2011. Body mass index (BMI) is the most commonly used measure to classify people into weight categories. While the use of BMI has limitations, as it does not take into account the difference between muscle and fat, it is a good quick indicator of increased risks. Obesity increases the risk of hypertension, coronary heart disease, deep vein thrombosis and pulmonary embolism. It is also associated with an increased risk of certain cancers. Obesity is an important risk factor for non-alcoholic fatty liver disease which if left untreated can progress to severe forms of liver disease, such as non-alcoholic steatohepatitis, fibrosis and cirrhosis. The risk of sleep apnoea is raised in obese individuals as is that for gastro-oesophageal reflux and gallstones, stress incontinence in women and erectile dysfunction in men. Lifestyle weight management programmes should be multicomponent, developed by a multidisciplinary team, and delivered by individuals who have undergone appropriate training. They should focus on long-term weight loss and prevention of weight regain and continue for a minimum of three months. Effective programmes include setting dietary targets, such as specific reductions in energy intake. Other options that GPs and practice nurses might offer within the practice, over and above referral to lifestyle programmes, include help with intermittent or regular motivational support, and/or drug therapy.


Asunto(s)
Obesidad/terapia , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Obesidad/complicaciones , Obesidad/epidemiología , Pérdida de Peso
14.
Biomed Res Int ; 2014: 626205, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25003122

RESUMEN

BACKGROUND: Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD) risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention. DESIGN: Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme. METHODS: The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated. RESULTS: Mean age of patients (533 males, 68 females) was 63.7 (6.4) years. High cholesterol (57%) was most prevalent, followed by smoking (53%) and high blood pressure (26%). Smoking (57%) made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26%) and raised cholesterol (17%). After one year of enhanced support, the modifiable population risk attributed to smoking (56%), high blood pressure (68%), and high cholesterol (53%) was removed. CONCLUSION: Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Conducta de Reducción del Riesgo , Enfermedades Cardiovasculares/diagnóstico , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Factores de Riesgo
15.
Perspect Public Health ; 134(3): 135-44, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-23656746

RESUMEN

AIMS: To explore 12-month changes in cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) in participants of a health trainer (HT) programme. METHODS: Participants were 994 adults with at least one established CVD risk factor who were referred to a HT programme. The primary outcome was 12-month change in Framingham 10 year CVD risk score. Secondary outcomes included change in individual risk factors and HRQoL. Intention to treat analysis was used to explore 12-month changes for the overall population and those classified 'high risk' (≥20% CVD risk) at baseline. RESULTS: At baseline, 33.6% of participants were classified as 'high CVD risk' and 95.7% were overweight or obese. There were modest 12-month improvements in most modifiable CVD risk factors, but not overall CVD risk (-0.25±6.50%). In 'high-risk' participants significant reductions were evident for overall CVD risk (-2.34±8.13%) and individual risk factors. Small, significant 12-month HRQoL improvements were observed, but these were not associated with CVD risk change. CONCLUSIONS: Significant CVD risk reductions in participants in this HT programme with high baseline CVD risk (.20%) in HRQoL in the population as a whole indicated that the programme in its current form should target high-risk patients.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Calidad de Vida , Conducta de Reducción del Riesgo , Anciano , Enfermedades Cardiovasculares/etiología , Bases de Datos Factuales , Inglaterra , Femenino , Centros de Acondicionamiento/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
16.
J Public Health (Oxf) ; 35(1): 92-8, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23104892

RESUMEN

BACKGROUND: As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. METHODS: A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. RESULTS: Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). CONCLUSIONS: The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Promoción de la Salud/métodos , Aceptación de la Atención de Salud/estadística & datos numéricos , Medicina Estatal , Adulto , Factores de Edad , Anciano , Comorbilidad , Estudios Transversales , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores Sexuales , Resultado del Tratamiento
17.
BMC Public Health ; 12: 944, 2012 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-23116213

RESUMEN

BACKGROUND: The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. METHODS: Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. RESULTS: Average population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group. CONCLUSIONS: The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Medicina General/métodos , Conducta de Reducción del Riesgo , Anciano , Inglaterra , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta , Factores de Riesgo , Apoyo Social , Medicina Estatal
18.
BMJ Open ; 2(6)2012.
Artículo en Inglés | MEDLINE | ID: mdl-23117563

RESUMEN

OBJECTIVES: This service evaluation examines how efficiently an innovative, simple and interactive blood pressure (BP) management intervention improves BP control in general practice. DESIGN: Prospective service evaluation. SETTING: Ten volunteer general practitioner (GP) practices in Stoke on Trent, UK. PARTICIPANTS: Practice staff identified 124 intervention patients and invited them to participate based on two inclusion criteria: (1) patient has chronic kidney disease (CKD) stages 3 or 4 with BP persistently >130/85 mm Hg or (2) patient is >50 years-old (without CKD stages 3-5) with BP persistently >140/90 mm Hg despite prescribed antihypertensive medication. Three selected hypertensive control patients per intervention patient underwent usual clinical care (n=364). INTERVENTIONS: Intervention patients used 'Florence', a simple, interactive mobile phone texting service with BP management intervention for 3 months, or for less time if their BP became controlled. Patients measured their BP, text their readings to Florence, received an immediate automatic response and had results reviewed by their GP/practice nurse at least weekly. MAIN OUTCOME MEASURES: Baseline data including recent BP readings and medications were collected; similar information was obtained for 6 months for both control and intervention patients. Average BP readings and medication usage were determined. RESULTS: At final data collection, five intervention patients had not yet completed the full programme. Control and intervention patients were well matched except that intervention patients had significantly greater baseline BP. Greatest BP reductions were among hypertensive intervention patients without CKD stages 3-5. Intervention patients had significantly more BP readings and more changes in medication over the 3-month data collection period. CONCLUSIONS: Simple telehealth is acceptable and effective in reducing patients' BP. In future, poorly controlled patients could be targeted to maximise BP reductions or broader use could improve diagnostic accuracy and accessibility for patients who struggle to regularly attend their GP surgery.

19.
BMJ Open ; 2(6)2012.
Artículo en Inglés | MEDLINE | ID: mdl-23192242

RESUMEN

OBJECTIVE: To determine the patient experience of using a simple telehealth strategy to manage hypertension in adults. DESIGN: As part of a pragmatic service evaluation, the acceptability of, satisfaction with and ease of use of a simple telehealth strategy was determined via text, cross-sectional questionnaire survey administered by telephone, case studies, discussion groups and informal feedback from practices. This simple telehealth approach required patients to take home blood pressure (BP) readings and text them to a secure server ('Florence') for immediate automatic analysis and individual healthcare professional review. PARTICIPANTS: 124 intervention patients who used the Florence system. SETTING: 10 volunteer general practitioner's (GP) practices in Stoke on Trent, UK, with poor health and high levels of material deprivation took part. RESULTS: Patient satisfaction was high. In particular, patients found the system easy to use, were very satisfied about the feedback from their GP regarding their BP readings, found the advice sent via Florence useful and preferred to send BP readings using Florence rather than having to go to the practice monthly to get BP checked. Overall satisfaction with the system was 4.81/5.00 at week 13 of the programme. Other advantages of being enrolled with Florence were improved education about hypertension, a greater feeling of support and companionship and flexibility which allowed self-care to occur at a time that suited the patient rather than their practice. CONCLUSIONS: This simple telehealth strategy for managing hypertension in the community was met with high levels of patient satisfaction and feelings of control and support. This management approach should thus be considered for widespread implementation for clinical management of hypertension and other long-term conditions involving monitoring of patients' bodily measurements and symptoms as a large number of meaningful readings can be obtained from many patients in a prompt, efficient, interactive and acceptable way.

20.
Qual Prim Care ; 19(3): 193-9, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21781435

RESUMEN

BACKGROUND: The NHS Health Check Programme presents the opportunity to reduce death and ill health caused by cardiovascular diseases (CVDs). Owing to the current restructuring of health care in the UK, financial resources will in future be limited. It is important to develop cost-effective ways of delivering this programme. There are practical alternatives to strategies that advocate using existing data to pre-stratify patients and prioritise those aged between 50 and 74 years. METHOD: Data on patients eligible for a health check were retrospectively collected from two early implementer practice teams. The characteristics of attenders and non-attenders, such as demographic factors, consulting behaviour, clinical measures and lifestyle measures, were collected. Costs of two approaches to delivery (drop-in clinic with choice of booked appointment versus booked appointment alone) were compiled. RESULTS: Nearly half of all patients had accessed their GP or practice nurse with four or more appointments in the 12 months prior to their health check. There remained a margin of error between estimated CVD risk (calculated prior to the health check by the practice, using existing information) and actual CVD risk (calculated after a health check had been completed). Drop-in clinics with choice of booked appointment cost half the price of offering patients the option of booked appointments alone. DISCUSSION: The cost-effectiveness of drop-in clinics was achieved by a reduction in staffing costs through intensively offering health checks; this approach provides a practical solution to maintaining a population-wide approach. Using existing data to pre-stratify patients is dependent on the quality and completeness of data used to estimate CVD risk. Concentrating efforts on 50 to 74 year olds may improve sensitivity to detect CVD but would reduce the chance of engaging with patients about their health at an earlier stage. Offering health checks opportunistically and using existing data no older than 12 months to complete a health check provide the potential for further cost savings.


Asunto(s)
Enfermedades Cardiovasculares/economía , Prioridades en Salud/economía , Servicios Preventivos de Salud/economía , Medicina Estatal/economía , Adulto , Anciano , Citas y Horarios , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/prevención & control , Análisis Costo-Beneficio , Recesión Económica , Femenino , Prioridades en Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/normas , Estudios Retrospectivos , Medición de Riesgo/métodos , Medicina Estatal/organización & administración , Medicina Estatal/normas , Reino Unido
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA