Centre for Patient Leadership: leadership award runner-up

David Gilbert (left) and Mark Doughty: 'We are about giving patients the confidence and the skills to engage with other professionals.' Photograph: Centre for Patient Leadership

A unique leadership programme is giving patients, their carers and service users a voice and helping them influence and shape the health services they use. The Centre for Patient Leadership was established three years ago by Mark Doughty, who has severe rheumatoid arthritis, and David Gilbert, who had a nervous breakdown when he was 25.

Both recognised from their own personal experiences the potential power of the patient voice, but both felt no support was available to make sure that voice was heard. Their own health experiences influenced their individual career paths. Between them they have expertise and skills in learning and development, advocacy and patient engagement.

Gilbert says: "We believe current engagement mechanisms are not fit for practice. Life-changing illness, injury or disability is the crucible within which leadership can be developed. Patients can have a vision of, and passion for, change borne out of their lived experiences. Stepping up to want to change things for others, requires learning and support to develop the confidence and capabilities to work with professionals to influence change."

Courses on offer, which are tailored to individual need, range from two months to a maximum of six months. They involve a mix of workshops with mentoring and coaching support, and focus on self-leadership, relationship building and dialogue, and developing influencing and advocacy skills.

Doughty says: "It's about building effective relationships, being able to communicate and having the ability to dialogue ... and talking together about problems that you share. We are about giving patients the confidence and the skills to engage with other professionals in which the patient themselves perceive themselves as being equal."

The company works with individual patients and organisations, which are trying to make patient engagement more meaningful. Between 400 and 500 people from a range of national, regional and local organisations including strategic health authorities and clinical commissioning groups have completed its leadership programme.

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Longer waiting times for GP appointments predicted as concerned GPs raise fears about the impact of cuts for patient care, UK

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 20 Aug 2013 - 1:00 PDT Current ratings for:
Longer waiting times for GP appointments predicted as concerned GPs raise fears about the impact of cuts for patient care, UK

Over 70% of GPs are forecasting longer waiting times for GP appointments within the next two years - as nearly half (47%) reveal that they have cut back on the range of services they provide for their patients.

In the latest survey by the Royal College of General Practitioners (RCGP) highlighting the growing crisis in general practice, more than 80% of respondents said that they now have insufficient resources to provide high quality patient care.

As well as the reduction in patient services, 39% of respondents to the ComRes poll also said they had cut practice staff and over half had experienced difficulty recruiting and retaining GPs.

Worryingly, four in five GPs were concerned that it will become increasingly difficult to deliver continuity of care to vulnerable elderly people - which has been highlighted as a priority by the English Health Secretary Jeremy Hunt. And 72% of GPs in England said that the amount of time they are able to spend on frontline patient care has been reduced as a result of the new clinical commissioning responsibilities they have been given.

The RCGP is now calling on all four Governments across the UK for an emergency package of additional investment for general practice - before there are disastrous consequences for patients.

Dr Clare Gerada, Chair of the RCGP, said: "The results of our survey paint a bleak picture for patients, the profession and the future of general practice. GPs are grappling with a 'double whammy' of spiralling workloads and dwindling resources, and big cracks are now starting to appear in the care and services that we can deliver for our patients.

"We are particularly concerned about the effect this is having, and will continue to have, on waiting times for GP appointments. We fully understand that patients are already frustrated - and GPs are doing their best to improve access to appointments - but the profession is now at breaking point and we do not have the capacity to take on any more work, without the extra funding and resources to back it up.

"GPs currently make 90% of patient contacts for only 9% of the NHS budget in England. Some GPs are making up to 60 patient contacts in a single day, which is not safe, for patients or GPs.

"We are working our hardest to make sure that patients are not affected but the status quo is no longer an option. We must have an emergency package of additional investment for general practice to protect GP services and protect our patients from even deeper cuts to their care and longer waiting times."

The RCGP survey is the latest in a series highlighting the growing crisis in general practice. The College is concerned that the current situation in A&E departments is overshadowing the very serious problems in general practice. A previous College poll by Research Now revealed that 85% of GPs now consider the profession to be 'in crisis' and half of GPs are no longer able to guarantee safe patient care.

Dr Gerada added: "General practice is the most cost-effective and efficient arm of the health service - GPs keep the rest of the NHS stable and secure. Once general practice starts to crumble, the entire NHS will follow with disastrous consequences for our patients.

"Last week the English Government announced an additional £500 million for A&E departments. What we need is our fair share of funding so that GPs can do more for our patients in their communities."

ComRes interviewed 206 General Practitioners online - 170 from England; 21 from Scotland; nine from Wales; and six from Northern Ireland - between the 7th August and 9th August 2013. Data are regionally representative by NHS Strategic Health Authority (SHA). ComRes is a member of the British Polling Council and abides by its rules. Full data tables are available on the ComRes website, www.comres.co.uk

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Expanded role for pharmacists in Canada is an opportunity to offer better patient care

Main Category: Pharmacy / Pharmacist
Article Date: 19 Aug 2013 - 9:00 PDT Current ratings for:
Expanded role for pharmacists in Canada is an opportunity to offer better patient care

The newly expanded role of pharmacists in Canada to help manage the health of patients can benefit both patients and physicians, according to an article in CMAJ (Canadian Medical Association Journal).

The article, written by a physician and a pharmacist, summarizes the opportunities for collaborative care and how physicians can work with pharmacists.

Pharmacists in Canada have recently been given broader responsibilities, including in some provinces, prescribing privileges, ability to order and interpret laboratory tests, and ability to vaccinate and inject medications. Pharmacists in other countries such as the United Kingdom, United States and New Zealand are also increasingly involved in collaborative care arrangements.

There is strong evidence that pharmacists' care can benefit patients, especially in providing vaccines and managing high blood pressure, diabetes, heart failure, asthma and other conditions.

"As pharmacists more actively participate in medication management, physicians should be aware that in interprofessional models of care, every member of the team is accountable for the care he or she provides and is not to be held directly liable for the acts of others," write Dr. Cara Tannenbaum, Faculties of Medicine and Pharmacy, Université de Montréal and Dr. Ross Tsuyuki, Faculty of Medicine and Dentistry, University of Alberta.

Because more than 10% of visits to emergency departments are for drug-related problems, collaboration can help reduce the number of drug?"drug interactions and avoid visits to the emergency department. Pharmacists, who have specialized expertise in drug dosing, drug interactions, pharmacology and related areas, can help physicians manage safe prescribing in complex (often elderly) patients taking 5 or more drugs. They can also help in tapering patients off medications.

"Once established, collaborative care with pharmacists will likely yield tremendous benefits to both patients and physicians. The expanding scope of pharmacists' practice offers many opportunities to improve patient care. However, it is also an ongoing process that must be evaluated as regulated activities change, new pharmacists enter practice and scopes of activities continue to expand," the authors conclude.

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"Bring your own device" to work tech trend helps nurses provide improved patient care

Main Category: Nursing / Midwifery
Also Included In: IT / Internet / E-mail
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
"Bring your own device" to work tech trend helps nurses provide improved patient care

Not long ago, hospital IT departments supplied and maintained the hardware and software that nurses used to perform work-related tasks. Then came the mobile revolution, when consumers increasingly began carrying smartphones and tablets to assist them in their personal lives as well as in business. As a direct result, many nurses today are following the trend known as BYOD - bring your own device.

"RNs have greater familiarity with their own devices and the more familiar they are, the greater the tendency there is for nurses to optimize the use of the device to its fullest capacity for improved patient care," says Judith Church, DHA, MSN, faculty member in the health care and health care informatics programs at American Sentinel University.

A recent survey by Fierce Mobile Healthcare found that 61 percent of hospitals and health systems responding said that half their employees use personal mobile devices for work. Fifty percent said this use was limited to email and calendar applications, but 36 percent said that employees were accessing patient data.

Another report, Point of Care Computing for Nursing 2012, examined the BYOD patterns of nurses and found that 69 percent of hospitals say their nursing staff is using personal devices at work.

The Pros and Cons of BYOD in Nursing
Church says that BYOD can increase productivity or job performance because people are more comfortable with their own device, have more control over the computing environment and enjoy an enhanced sense of work-life balance, to name a few benefits.

The nurses surveyed in the report specifically stated they use their own mobile devices to improve patient safety and reduce the risk of medical errors. They believe their personal devices enable them to fill in critical communication gaps with the technologies provided by the hospital - for example, allowing them to easily access clinical reference materials at the point of care or quickly communicate with other clinicians to coordinate care.

Yet, BYOD can put IT departments in the difficult position of having to provide support for all these personal devices.

For example, IT might have to build a platform that will ensure hospital software works on all four mobile operating systems (Apple, Android, Microsoft Windows and Blackberry). These diverse devices also create security and HIPAA issues associated with mobile technology.

"The drawback to BYOD in nursing is that it contributes to a non-standardization of a work arena's equipment," says Church. "Nurses should realize that IT policies exist for a reason to protect data integrity and security and should adhere to them at all times when participating in a BYOD initiative."

Using BYOD to Improve Nursing Workflows
Integrating BYOD with nursing call systems can improve both staff and patient satisfaction. Call systems based on overhead paging or lights that can only be seen from the nursing station may soon become obsolete in favor of newer systems that can wirelessly transmit alerts right to a nurse's smartphone when the patient pushes a button.

Alerts can take the form of text messages, emails, pages or phone calls. In some cases, patients may be able to send a specific type of alert - a request for bathroom assistance or pain medicine, for example - that are then routed to the appropriate staff person.

"BYOD can play a significant role in nursing to improve workflows," says Church. "The individual device and user prowess will contribute to optimal standardization of devices across the physical and electronic work environment."

Church points out that BYOD is a trend that will continue in health care because of its financial implications.

"The BYOD trend will thrive in nursing because health care organizations save money when the employee purchases the device. Since nurses are most familiar with their own devices, they will work more effectively and efficiently. Equipment - no matter what it is - is only as effective as its setup and use," adds Church.

It's clear that health care must find ways to reap the benefits of mobile technologies, while reducing the risks and protecting patient data.

"BYOD initiatives should be expanded to include nurses as well as physicians in order to increase nurse productivity and improve patient care and satisfaction," adds Church.

For more information about American Sentinel University's MSN, nursing informatics specialization, please visit http://www.americansentinel.edu/health-care/m-s-nursing/m-s-nursing-nursing-informatics.

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NHS patient information leaflets are "inaccurate, inconsistent and confusing", UK

Main Category: Public Health
Article Date: 31 Jul 2013 - 0:00 PDT Current ratings for:
NHS patient information leaflets are "inaccurate, inconsistent and confusing", UK

The NHS's patient information leaflets are "inaccurate, inconsistent, and confusing and effort is duplicated" argues GP Margaret McCartney on bmj.com.

In a feature published on 30 July, Dr McCartney says the NHS is "awash" with patient information and with many trusts commissioning leaflets from external companies and others writing their own, it is difficult to know how efficient and effective these leaflets are.

In a personal view, Dr McCartney says the NHS is "awash" with patient information and with many trusts commissioning leaflets from external companies and others writing their own, it is difficult to know how efficient and effective these leaflets are.

Previous studies have shown that leaflets are providing patients with inconsistent guidance and others are giving conflicting advice. As such, patients are being given very different information depending on where they live.

A study carried out on one set of leaflets for the removal of kidney stones found they did not consistently mention common complications and had a wide variation of information on drugs and pain-killers. Furthermore, complications were often inadequately explained.

Sir Muir Gray, co-chair of the executive council of the Information Standard (a scheme for organisations producing evidence based healthcare information for the public), said "It's a stupid system, a waste of money, and, without rigorous standards [...] the information is biased and misleading".

McCartney says that the problem of varying leaflets is not new: a BMJ investigation in 1998 found inaccuracies and outdated information in leaflets given out by general practitioners.

One researcher at the University of Oxford says the problem is that "the NHS still fails to take this seriously", adding that, at the moment, in most NHS trusts there is no one who has responsibility. This means that leaflets can end up amateurish "with the evidence and uncertainties not expressed clearly".

One spokesman told the BMJ that NHS England is, however, launching a "major project" in September which they hope will "standardise all information".

McCartney concludes that the challenge now is "to adopt high standards [...] updating information regularly and making it easily accessible". She adds that "this is one area of the NHS where efficiency savings look ripe for the picking".

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Ventilation in OR may be affected by patient warming systems, with possible impact on infection risk

Main Category: Public Health
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 28 Jul 2013 - 0:00 PDT Current ratings for:
Ventilation in OR may be affected by patient warming systems, with possible impact on infection risk

Forced-air systems used to keep patients warm during surgery may affect the performance of operating room (OR) ventilation systems - potentially increasing exposure to airborne contaminants, reports a study in the August issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

By comparison, conductive warming systems don't disrupt ventilation airflows over the surgical site, according to the report by Dr Kumar G. Belani of University of Minnesota and colleagues. But an accompanying editorial notes that there's not yet enough evidence to change current practice with regard to patient warming in the OR.

Patient Warming Affects OR Ventilation Airflow The researchers compared the effects of two different types of patient warming systems on airflow in the OR. Modern ORs use "sophisticated ventilation systems to create localized zones of highly filtered air over the surgical site," according to Dr Belani and coauthors.

For the experimental study, the researchers set up an OR as for knee replacement surgery, using a mannequin. They then assessed the performance of the OR ventilation system using "neutrally buoyant detergent bubbles," which made it possible to visualize airflow patterns under different conditions.

Airflow was compared using a forced-air warming system, which distributes heated air under the surgical drapes and over the patient; and a conductive warming system (such as heated water blankets), which applies direct heat to the patient's skin.

Forced-air warming "generated hot air convection currents that mobilized bubbles over the anesthesia site and into the surgical site," Dr Belani and colleagues write. The average "bubble count" in the simulated surgical field was more than 100 with the forced-air warmer, compared to about 0.50 with a conductive warming system.

The convection currents created by the forced-air system drew air from under the surgical drapes and into the surgical site. The concern is that this could mobilize bacteria or other contaminants from nonsterile areas, or interfere with the ventilation system's ability to clear contaminants from the surgical site.

Too Early to Assume Increased Infection Risk? The use of " downward displacement" OR ventilation systems had previously been shown to reduce exposure to microbes and infection rates during certain types of surgery. But more recent studies have found no reduction in infection rates. The new study was designed to test whether forced-air warming systems - a relatively recent introduction to ORs - could be affecting ventilation performance.

The results suggest that forced-air patient warming systems may indeed affect airflows in the OR, potentially increasing exposure to bacteria and other contaminants during surgery. Dr Belani and coauthors conclude, "These findings warrant future research into the effects of forced air warming excess heat on clinical outcomes during contamination-sensitive surgery."

In the editorial, Drs Charles Weissman and W. Bosseau Murray note that the findings provide only indirect evidence of potential infection risk, in a simulated setting. That's in contrast to the known benefits of preventing drops in body temperature during surgery. Pending further research, Drs Weissman and Murray write, "[T]he prudent course...might be to continue with the presently proven successful warming therapies, but keep an open mind about the possible future need to change practice."

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Read the article in Anesthesia & Analgesia: http://www.anesthesia-analgesia.org/content/117/2/406.full?. The journal is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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How telehealth can improve patient care

Telecare should involve interaction as well as technology, says Simon Fradd. Photograph: Murdo Macleod

The NHS is facing a £30bn hole in its budget by 2020 and Clare Gerada, chair of the Council of the Royal College of GPs has said that we are currently short of 8,000 GPs, and by 2021 we shall need an additional 16,000.

It's obvious that the current way of delivering healthcare within the NHS is not sustainable.

There is already wide recognition of this and the development of integrated care pathways is evidence of progress. However, the savings generated are limited and the shift of location of care simply puts an even greater burden on general practice and primary care. Real savings come through removing the need for NHS care.

Britain is not alone in facing this problem. In the US, the Obamacare changes will give an additional 70 million people access to healthcare. The issue there is not financial – they have allocated a budget of $400bn – but the lack of a trained and skilled workforce.

In China the problem is even greater, as more than one billion people move from traditional forms of healthcare to western-style services. So it's no surprise that the annual international self-care day started in China last year on 24 July 2012.

What is interesting is the different focus that is emerging. In Europe the prime target for self-care has been around the management of minor self-limiting conditions, which account for 20% of GP consultations. However, the focus of the international self-care day movement is non-communicable diseases, which account for over 60% of NHS spending. It is this element of expenditure which is ballooning.

The initial focus is on illness prevention: living healthy lifestyles to improve quality and quantity of life. This only defers the need for healthcare, however. All our bodies start to fail at some point. The big issue in terms of self-care is full involvement in the management of one's own illness, especially long term conditions.

I have never understood why clinicians believe themselves to be the experts. Diabetics spend on average 3.5 hours a year with a clinician. For the remaining 8,756 hours they are on their own with minimal support. I have just been involved in an audit of readmissions to a major London teaching hospital within 28 days of discharge. The results were fascinating: a common theme was the lack of a clear ongoing care plan agreed with the patient and communicated before discharge to the GP and the patient's carers. I even came across a chronic bronchitis discharged without rescue medication.

Even where best practice is initiated, it is not always followed. I have been a patient in the past three years and am aware just how disempowering it is. Even as a GP who has been practising for 40 years, I waited to be told what to do rather than acting on my own initiative. What every patient needs is their own healthcare professional who can give reassurance and advice as soon as it's needed.

That scenario is now available, with telecare and telehealth. It astounds me that it is taking so long to become the norm. Placing this technology in a patient's home as part of a complete package of care can revolutionise their wellbeing as well as reduce hospital admissions. It does this at the same time as reducing GPs' workload, by interactively monitoring individuals in their home.

The vital thing here is interaction. As well as the technology, there must be a skilled, trained individual monitoring the data and interacting with the patient. If a chronic obstructive pulmonary disorder sufferer's breathing deteriorates, early advice to use rescue medication can avoid hospital admission. The same can apply to heart failure patients who gain weight as a result of fluid retention.

We are not going to get another 16,000 GPs or an additional £30bn. It's time to support patients in their role as experts in their own health. A prime plank of this should be telehealth.

Dr Simon Fradd is a GP in Southwark

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