New Website for @RealisticMed Launched

A new website dedicated to practising Realistic Medicine has been launched this week. Realistic medicine refers to putting the person receiving health and social care at the centre of decisions about their care and creates a personalised approach. It encourages health and care workers to find out what matters most to their patients and clients so that the care of their condition fits their needs and situation. Realistic medicine recognises that a ‘one size fits all’ approach to health and social care is not the most effective approach for the patient or for the NHS.

Its important to older people because it encourages services to adapt to the way in which people with multiple, complex and frequently changing conditions require to access care and support. Those people are primarily over 65. Current models of healthcare services are stretched and there is need to re-examine how we can deliver person-centred and integrated healthcare that embraces both statutory and non-statutory agencies. Cath Calderwood, the Chief Medical Officer for Scotland has said, realistic medicine involves

  • Listening to understand patients problems and preferences;
  • Shared decision making between healthcare professionals and their patients;
  • Ensuring that patients have all the understandable information they need to make an informed choice;
  • Moving away from the ‘doctor knows best’ culture to ensure a more equal partnership with people;
  • Supporting healthcare professionals to be innovative, to pursue continuous quality improvement and to manage risk better;
  • Reducing the harm and waste caused by both over-provision and under-provision of care;
  • Identifying and reducing unwarranted variation in clinical practices

The new website which you can access HERE, features resources, good practice case studies and the contact details of Realistic Medicine Leads within the NHS Scotland Boards.

Comorbidity and Dementia in England

If you know me or have to sit through my classes; you will know that I have a keen interest in multimorbidity and its impact on older people. So this week I have to mention that Public Health England (PHE) published a report with findings from an analysis of a sample of anonymised primary care records highlighting the prevalence of diagnosed comorbidities in people living with dementia (in England).

The comorbidities considered in the analysis were hypertension, coronary heart disease (CHD), stroke or transient ischaemic attack (TIA), diabetes, depression, severe mental illness or psychosis, Parkinsonism, epilepsy, chronic obstructive pulmonary disease (COPD) and asthma. The data set used for the analysis was the Health Improvement Network (THIN).

Key findings from the report revealed that

  • 77% of people living with dementia also had at least one other health condition that is mentioned in the list above. So close to 8 people in every 10 diagnosed.
  • Among, people living with dementia hypertension was the most common comorbidity (44%). The prevalence of diabetes, stroke or TIA, CHD or depression ranged between 17-20%, while that of Parkinsonism, COPD or asthma ranged between 9-11%.
  • The prevalence rates for eight of the 10 comorbidities were higher in people living with dementia than you would expect in other people. Only the prevalence of hypertension and asthma was higher in other people.
  • The likelihood of multiple comorbidities was higher in patients with dementia.
  • 22% of people living with dementia had ≥3 comorbidities and 8% had ≥4 comorbidities, compared with just 11% exhibiting 3 or more comorbidities and only 3% exhibiting 4 or more in the wider GP population.
  • At the age of 85 people living with dementia were highly likely to have ≥2 comorbidities compared with other 85 year olds.

The data also shows that different types of dementia lead to different patterns of comorbidities being diagnosed.

Not surprisingly vascular dementia is associated with the cardiovascular conditions, but surprisingly it is also more associated with respiratory conditions than the other forms of dementia.

To see the report CLICK HERE

If you want to know more about this interesting topic then maybe you could read my chapter in the Textbook of Dementia Care.

I know it’s shameless self-publicity!

It’s Allied Health Professions Day! Let’s Celebrate Their Work #AHPsDay #AHPsDayScot #ProudToBeAHP

There are fourteen different healthcare roles recognised as Allied Health Professionals (AHPs); each one of them carrying out an important role in the lives of the people that they are caring for. If you want to find out more about the 14 professions see the following page at Health Careers

So this week rather than focusing on a paper or a topic that’s in the news let’s  just highlight what the 14 professions do and how they make a difference.

As part of the day a Google site has been created and on the site is a whole lot of material of use to help people understand AHP roles and the contributions they make. The site can be found HERE 

It includes video, NHS Recruitment information, some materials from the AHP’s  professional bodies and some teaching materials.

The Nursing Midwifery and Allied Professions group at NHS Education for Scotland have also released a series of videos from their AHP staff on the programmes that they are currently involved in which you can view at https://twitter.com/NESnmahp

This week the Alzheimers Scotland Blog “Lets Talk About Dementia” are also running a serieds of Blogs on AHP contributions to Dementia care which you can access at https://letstalkaboutdementia.wordpress.com/

So lots to celebrate and be proud of if you are an AHP. AND if you are an AHP reading this Blog have a great day and keep up the good work!

Hospital Admissions of Older People Continue to Rise

This week the SCoOP report was published. Otherwise known as the Acute Hospital Outcomes Report 2017/18; it provides an overview of the outcomes of acute geriatric medicine services in Scotland and is published by Scottish Care of Older People National Audit Project which amongst other things is trying to evaluate the variation in service provision for older people who require health and social care in various settings, to serve as a driver for standardisation and improvement of care across Scotland.

They have reported that admissions to geriatric medical wards in Scotland’s 19 largest hospitals with major emergency departments have risen by 10% for three consecutive years, reaching 43,311 in 2017/18.

The report has also concluded the length of stay dropped across all sites by an average of one day over the same period.

More concerningly they have noted the number of admissions varied widely across sites in Scotland, with some areas showing large increases in activity while others are in decline. There was also a large variation in the typical length of time patients spent in different hospitals. In some cases, there were up to 12-fold differences in the length of stay, while hospitals with higher activity levels usually had lower lengths of stay.

There was also a strong relationship between the time waiting to get to a specialist bed and the overall length of time patients spent in hospital; suggesting that delays in accessing specialist services contribute markedly to longer stays in hospital.

Differences in readmission rates and mortality were less marked between hospitals, broadly remaining stable over the last three years.

The report does not attempt to explain the variations but aims to stimulate discussion, learning and action that could be used to help benchmark some key patient outcomes and encourage interorganisational learning.

Professor Graham Ellis, Co-Chair of SCoOP Steering Group and the National Clinical Lead for Older People, Healthcare Improvement Scotland said:

“The wider goal is to reduce unwarranted and unjustifiable variation in outcomes, which may represent a threat to patient safety and/or a failure to learn from best practice.”

 

Have You Looked at the NHS Apps Library?

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Did you know that the NHS (in England) has been developing an NHS Apps Library.

Created in 2017; NHS Digital has worked with more than 350 developers to provide a library of digital health tools which are accessible to everyone. The Apps can be trusted because they are assessed rigorously before making the platform. This assessment also means that they are easy to use.

Since 2017, the library has been growing and covers many health and care needs including

  • support to prevent and manage diabetes including diet, exercise and lifestyle change
  • mental health apps offering advice and support on managing thoughts, feelings and behaviour and coping with panic attacks
  • apps to support personal well-being and a healthy lifestyle
  • tools to help manage the symptoms of chronic conditions such as asthma and high blood pressure
  • support to cope with the impact of breast cancer

Last year the Apps Library had already proved to be a great success. There was over a quarter of a million visits from launch to summer 2018 and more than half of those were from mobile phones, which shows how patient access to health care is transforming.

Digital Health continue to work with developers to offer apps which are relevant, helpful and empower patients to manage their own condition, which has been proven to lead to better outcomes.

To visit the library CLICK HERE

Having the NHS Apps Library also helps the public navigate the confusing array of health apps, advising them which apps have met NHS standards. Now they have added an NHS App which provides a simple and secure way for people to access a range of NHS services on their smartphone or tablet.

Come on NHS Scotland its time to catch up! I could only find these so far.

https://www.nhsinform.scot/care-support-and-rights/tools-and-apps and http://www.knowledge.scot.nhs.uk/home/mobile/mobile-knowledge.aspx

You might also find this interesting http://myhealthapps.net/ which was originally a European Directory of Health Apps.

One in Five UK Hospital Patients are Harmful Drinkers

A team mainly from Kings College in London conducted as part of the first author’s MRC Addiction Research Clinical (MARC) Fellowship, has found that 1 in 5 in-patients in the UK hospital system uses alcohol harmfully, and that 1 in 10 is alcohol dependent.

They conducted a systematic review and meta-analysis that looked at studies of any design that reported the prevalence of one of 26 wholly attributable alcohol conditions defined by the WHO’s International Classification of Diseases, Version 10 (ICD‐10).

They looked at 124 studies which were all conducted in one or more of the constituent nations of the United Kingdom and in an in‐patient setting (general wards, intensive care units, accident and emergency departments or mental health in‐patient units). The 124 studies meant that they were reporting on a total of 1 657 614 patients.

Having arrived at what is a shocking statistic they have rightly suggested that hospital staff need to be skilled in the diagnosis and management of alcohol‐related conditions given the number of people that they will see as inpatients. They have also pointed out that formal screening for alcohol‐related conditions in hospital remain low and that needs to change

Given the fact that other less prevalent diseases such as diabetes, are routinely screened for and often have dedicated in‐hospital specialist care teams their study provides weight  for increased routine universal screening and support to improving everyone’s training concerning alcohol‐related conditions given this high frequency of encounters.

This study is very pertinent given the UK government’s development of a new alcohol strategy and the NHS 10‐Year Plan which included funding allocations to combat alcohol‐related conditions.

Last year figures suggested that at least 41 English hospitals do not currently have an alcohol care team (ACT’s) in place. This is despite the 10 year plan including a commitment to place ACT’s in hospitals with the highest rate of alcohol dependence-related admissions (according to this study that will be all of them!) although the plan for increasing ACT’s, does not seem to have to any material funding.

To view the whole report see

Roberts E, Morse R, Epstein S, Hotopf M, Leon D, Drummond C. The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta-analysis and meta-regression. Addiction. 2019 Jul 3 [Epub ahead of print]. doi: 10.1111/add.14642. PMID: 31269539

Alzheimer Scotland Dementia Nurse Consultants Supporting #DAW2019 and Doing Their #oneweething

I am going to cheat this week and not write my own Blog piece. Instead I am going to provide a platform for two other people I know and another Blogging site called — Let’s Talk about Dementia.

The Let’s Talk about Dementia Blog was set up following on from Scotland’s Dementia Awareness Week 2014 which focused on the theme “lets talk about dementia”.  Five years later the Blog is still talking about Dementia because talking helps us make sure that nobody faces dementia alone. The Blog shares the work and practice of the allied health professionals in relation to dementia care and offers advice for people living with dementia, their carers, partners and families.

This week is dementia awareness week in Scotland and on the 7th of June Helen Skinner and Lyn Irvine, two of Scotland’s Dementia Nurse Consultants wrote this piece for  Lets talk about Dementia, which I am happy to share! Look for the 5 key things guide for people coming into hospital which they mention.

The Alzheimer Scotland Dementia Nurse Consultant (ASDNC) Group are excited to have launched two new documents at the Alzheimer Scotland Dementia Awareness Week conference on the 3rd June and then sharing this work in our first ever blog post. The first document is the ‘Leadership and Innovation in Hospital Care: Alzheimer Scotland Dementia Nurse Consultant […]

via Alzheimer Scotland Dementia Nurse Consultants Supporting #DementiaAwareness week — Let’s Talk about Dementia