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Paul Buchanan: On being the token patient

1 Dec, 16 | by BMJ

peb-photo-jpgHealthcare systems have been built with hierarchies, processes, and models of engagement that are designed to distill policy, research, therapy, diagnostics, treatment, and support down to the patient. The patient and their treatment is the “end-game.

But how well does the system work? Let’s take a look from a patient’s perspective. Several recent examples weeks spring to mind. more…

Daniel Whitney: Mental health has still not achieved “parity of esteem”—even among some medical professionals

1 Dec, 16 | by BMJ

daniel_whitney

It’s late morning; little piles of lists and notes from assessments carried out in the past 24 hours are littered between me and the PC. The assorted paraphernalia that seems to accumulate around me after a night on-call clutters my surroundings: a dictaphone, the British National Formulary, Maudsley guidelines, and the semi-completed audit I glance at guiltily every time I find something more urgent to do.

The medical students enter. I welcome them and realise that I had agreed one could present a history they had taken. I had felt guilty earlier; they had been struggling to find patients who met their tick box quota of “cases,” more…

Vineet Chopra et al: Motivational interviewing for healthcare providers

30 Nov, 16 | by BMJ

Improving patient safety through behavioral change is something that all healthcare providers strive to achieve. Supported by a three year grant, we are involved in a new way of doing this by using motivational interviewing (MI) among staff to improve patient outcomes.

A technique typically used by clinicians for patients, MI aims to empower and guide individuals towards health behavior change. Research studies have shown that MI achieves superior results compared to traditional patient education interventions for health behaviors including tobacco use, physical inactivity, and weight gain/obesity. more…

John J Park and Rifat Atun: Will global health be Trumped?

30 Nov, 16 | by BMJ

Donald Trump’s election as the 45th President of the United States (US) has left many in the global health community startled. What lies ahead for the future of global health and sustainable development, especially for millions of vulnerable people largely dependent on US assistance for health?

When Donald Trump famously announced: “I am not running to be President of the World. I’m running to be President of the United States,” he was probably not considering the fact that as the new US President, he would have tremendous influence on global health. [1] His responsibilities as President will include, among others, appointing the heads of the US Agency for International Development (USAID), Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH). Collectively, these organizations account for a large proportion the US Government’s $10 billion overseas assistance for health each year. [2] more…

Lorraine Atkinson: Preventing prison suicides

30 Nov, 16 | by BMJ

prison_cell2016 will be remembered for many reasons. I will remember it as the worst year on record for the number of prisoners who have taken their own lives in prisons in England and Wales.

More than 100 people have died by suicide in prison since the beginning of 2016. There are five weeks remaining yet already this is the highest death toll since current recording practices began in 1978. more…

Tiago Villanueva: Primary care in Brazil’s largest favela

29 Nov, 16 | by BMJ

tiago_villanuevaWalking through Rio de Janeiro’s largest slum, Favela da Rocinha, in the pouring rain is probably not the wisest thing for a foreign visitor to do. But on a recent trip to Rio, I was determined not to squander the one chance I had to visit the Maria do Socorro Silva e Souza Family Health Clinic—one of Rocinha’s three primary care clinics that belong to Brazil’s public “Unified Health System.” I went with a group of about 15 GPs from all over the world. The clinic provides care to about 33 000 inhabitants of Rocinha, which has an estimated population of around 100 000, and covers a very well defined area of the favela.

I had heard about the impressive developments in primary care in Rio de Janeiro over the past few years, where primary care coverage has gone from about 4% to about 70% within a decade. more…

Harry HX Wang and Sian M Griffiths: A primary care oriented approach to pursue population health in China

29 Nov, 16 | by BMJ

From Healthy China 2020 to Healthy China 2030

Seven decades ago, China’s healthcare was characterised by barefoot doctors who demonstrated the contribution of primary care to improved population health. Subsequent reform, however, restructured the healthcare delivery model to focus on providing curative care in a market driven system as opposed to spending on preventive care. Despite progress made through recent policies on expanding insurance coverage, the scope of insurance packages is limited to guarantee only the minimum health needs. [1] In the absence of gatekeeping in primary care, the ability to pay impacts on people’s healthcare utilisation [2] The escalation of out-of-pocket payments often results from fragmented care and multiple hospital visits due to patients’ preferential use of secondary over primary care. [3] Since long-term conditions and multimorbidity have become the greatest threats to population health, there is an urgent need to re-establish strong primary care with equitable health care service delivery. [3] more…

Delan Devakumar et al: Politicians need to first do no harm

28 Nov, 16 | by BMJ

It’s been a monumental year. The UK’s decision to leave the European Union and the Chilcot report on the Iraq war prompt us to wonder why these self-inflicted problems ever happened. The legacies of David Cameron and Tony Blair will be dominated by Brexit and Iraq respectively. Different in many ways, but each was a self-inflicted political wound, with profound consequences for us all. Why cause these problems?

more…

Aser García Rada: Living in limbo in Greece’s refugee camps

28 Nov, 16 | by BMJ

Aser García Rada_BMJFrom late March to late August I worked in two Greek camps for refugees as part of a joint Spanish-French Red Cross deployment to support the Hellenic Red Cross. Providing care to people, many of whom were originally middle class, in the developed but wobbling Greece carried with it certain peculiarities.

I began and finished in Ritsona, a refugee camp located in the midst of a forest area 70 km north from Athens and currently home to around 400 people. The camp is being managed by the Greek Air Force and, initially, when aircrafts performed their exercises some children panicked. more…

Valentina Lichtner: Incorrect patient record selection

28 Nov, 16 | by BMJ

valentina_lichtnerRecently the Wall Street Journal alerted its readers to a report by the ECRI Institute in the US on the common problem of patient misidentification. [1,2] The study found 7613 “wrong patient” incidents reported across 181 organizations in the period January 2013 to July 2015. Selecting the wrong electronic record was one example of this type of incident.

The consequences of record mis-selection can be serious and include patients receiving the wrong medications, incorrect results, diagnosis, and history of illness. The incidents always involve an error of commission (e.g. giving treatment that should not have been given) and one of omissions (e.g. not giving the treatment as intended), and two patients: the patient whose wrong record has been selected, and the patient who was the intended recipient. more…

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