Health Quality Improvement Partnership | May 2019 | Report Synopsis – National Clinical Audit of Specialist Rehabilitation following Major Injury
Health Quality Improvement Partnership (HQIP) have produced a synopsis of the third and final report on the provision of specialist rehabilitation following major trauma. The review was formed of three parts: an organisational audit, a prospective clinical audit, and a feasibility study.
The report found that access to specialist rehabilitation appears limited and needs much closer attention paid to the implementation of the standards that already exist. There will be different models of improving such access, depending on the set up of the services in the different areas of the country. Nevertheless, when designing and managing trauma networks compliance needs to be reviewed to these standards to see how it can be improved (Source: HQIP).
A new study published in The Lancet reports that patients who experience stroke as part of a brain hemorrhage are able to take medicines such as aspirin, without raising their risk factor of experiencing another stroke.
Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events.
The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (more than or equal to 18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627).
Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years. 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy, and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy.
These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention.
The latest edition of Health Matters from Public Health England focuses on taking a life course approach to the prevention of ill health and explores the evidence base for this approach. The resource signposts to evidence-based interventions and tools, as well as to evaluation and monitoring techniques.
Unlike a disease-oriented approach, which focuses on interventions for a single condition often at a single life stage, a life course approach considers the critical stages, transitions, and settings where large differences can be made in promoting or restoring health and wellbeing.
A life course approach values the health and wellbeing of both current and future generations. It recognises that:
there are a wide range of protective and risk factors that interplay in health and wellbeing over the life span
maintaining good functional ability is the main outcome of the life course approach to health
functional ability can be enhanced throughout life by a supportive environment
by altering policies, environments, and societal norms, inequalities affecting the life course trajectory can be reduced, which could benefit the whole population across the lifespan, as well as future generations
In terms of tackling health inequalities across the life course, there are multiple actions that can be taken, for which PHE have relevant resources. These include:
Diabetes Times | May 2019 | National campaign promotes insulin safety
This week to mark Insulin Safety Week (20-26 May 2019) over 500 diabetes teams predominantly in hospitals from the UK and Ireland will promote the message of insulin safety.
According to the results from the latest National Diabetes Inpatient Audit, extrapolated by the Diabetes Times, two in five people with diabetes on insulin (40 per cent) experience an error related to the administration of the drug while in hospital.
In response, the seven-day awareness campaign in an attempt to reduce incidents of insulin errors as part of Insulin Safety Week.
A total of 343 sites, mainly hospitals and GP surgeries, took part in the first-ever national Insulin Safety Week in May 2019, building on interest generated by successful local campaigns across the country in 2017, including in Leicester, Hastings, Eastbourne and Southampton.
A retrospective population-based study, that used linked primary and secondary health lectronic health records from 93,000 patients who were diagnosed with heart failure between 2002 and 2014, aimed to investigate the medical care received by heart failure patients in the UK from diagnosis up to a year later. The authors find that management of heart failure patients in the UK presents important shortcomings that affect screening, continuity of care, and medication titration and disproportionally impact women and older people. They also report that patients were most likely to be diagnosed in hospital rather than by their general practitioner, received insufficient follow-up after hospitalisation, and dosages prescribed to patients were too low. Moreover, gaps in care were more common in women, older people, and, to some extent, socioeconomically deprived individuals.
Why was this study done?
Heart failure is a common, costly, and severe condition—it affects about 2% of the population in high-income countries, with mortality rates comparable to the gravest forms of cancer.
Effective treatments exist but involve a complex process of investigations, stepwise initiation of medicines, and dose adjustments that in practice is often challenging to follow.
Over the past decade, the UK introduced separate programmes to evaluate and improve the management of heart failure patients in primary and secondary care. However, patients’ trajectories of care across different healthcare settings have not been studied.
What did the researchers do and find?
We aimed to investigate the medical care received by heart failure patients in the UK from diagnosis up to a year later.
We investigated trajectories of care, including where patients were diagnosed, investigations that were performed, and medications they received, examined changes over time and if results differed according to patients’ age, sex, or socioeconomic status.
Our results show that the medical care received by heart failure patients presents important gaps. Patients were more likely to be diagnosed in hospital rather than by their general practitioner, received insufficient follow-up after hospitalisation, and dosages prescribed to patients were too low. Moreover, gaps in care were more common in women, older people, and, to some extent, socioeconomically deprived individuals.
What do these findings mean?
Heart failure care in the UK presents important gaps that pertain to patients’ long-term care needs and are likely to negatively impact patients’ health and quality of life.
Nationwide quality improvement programmes have failed to identify these gaps, essentially because they evaluate each individual healthcare setting on its own. To further improve patient care, health systems may need to reflect on patients’ journey across the continuum of care.
Women, older people, and deprived populations are particularly prone to receiving suboptimal care. Research that helps us understand the reasons behind these disparities, or models of care that take each group’s specificities into account, could help. (Source: Conrad et al. 2019)
John Appleby from the Nuffield Trust reports that for the second year of mandatory reporting on the gender pay gap shows localised improvement, but half of NHS organisations reported a growing gap between men and women’s earnings. Appleby asks : now that the deadline for the second year’s reporting has passed, have things changed in NHS organisations? Are they closing the gap? Overall, the short answer is no, though some individual organisations seem to have improved (Source: BMJ).
Department of Health and Social Care | May 2019 | NHS accountability framework 2019 to 2020
The government’s accountability framework with NHS England and NHS Improvement sets out their objectives and budgets for 2019 to 2020.
The accountability framework combines the annual statutory mandate to NHS England with its remit for NHS Improvement. The financial directions to NHS England provide further detail on how NHS England’s budget is broken down (Source: Department of Health and Social Care).