Ricky Banarsee

Ethnic disparities in diabetes management: a 10-year population-based repeated cross-sectional study in UK primary care

BACKGROUND There has been little research on the impact of quality improvement initiatives on ethnic disparities in diabetes management in the UK. METHODS Population-based, repeated cross-sectional survey of recorded measurements, prescribing and achievement of treatment targets among 4309 patients with diabetes mellitus using electronic medical records from 26 general practices in North-West London from 1997 to 2006. RESULTS Proportions of patients having their blood pressure (BP), cholesterol and HbA1c measured and recorded increased over the study period [from 50.6% to 87.0% (P < 0.0001), 17.0% to 76.7% (P < 0.0001) and 32.9% to 74.1% (P < 0.0001), respectively]. However, some ethnic differences remained. Black patients with diabetes were less likely to achieve target BP (<140/80 mmHg) than the white group [2006 age-sex adjusted odds ratio (AOR), 0.65; 95% confidence interval (CI), 0.51-0.83]. South Asians were found to have better lipid target control (2006 AOR, 1.57; CI, 1.23-2.00), were more likely to receive oral hypoglycaemic agents (2006 AOR, 2.27; CI, 1.79-2.86) but less likely to receive insulin (2006 AOR, 0.54; CI, 0.42-0.69) than the white group. CONCLUSIONS Although ethnic disparities persist in diabetes management in this study population, these are starting to be addressed, particularly in the South Asian group. All ethnic groups have benefited from recent quality initiatives in the UK.

Trends in hospital admissions for sickle cell disease in England, 2001/02–2009/10

BACKGROUND Sickle cell disease (SCD) is a rising cause of mortality and morbidity in England and consequently an important policy issue for the National Health Service. There has been no previous study that has examined SCD admission rates in England. METHODS Data from Hospital Episode Statistics were analysed for all hospital episodes (2001/10) in England with a primary diagnosis of sickle cell anaemia with crisis (D57.0) or without crisis (D57.1). Secondary and tertiary diagnoses were examined among those patients admitted with either of these codes as their primary diagnosis. RESULTS The overall SCD admission rate per 100 000 has risen from 21.2 in 2001/02 to 33.5 in 2009/10, a rise of over 50%. London accounts for 74.9% of all SCD admissions in England. 57.9% of patients admitted are discharged within 24 h. The largest rise in admission rates was seen among males aged 40-49 years where admission rates per 100 000 increased from 7.6 to 26.8 over the study period. CONCLUSIONS Our data show that SCD admissions are rising in England, particularly in London. Over half of patients admitted with SCD were discharged within 24 h, suggesting that some of these admissions could be prevented through better ambulatory care of patients.

Characterizing emergency admissions of patients with sickle cell crisis in NHS brent: observational study

Objectives To characterize emergency admissions for patients with sickle cell crisis in NHS Brent and to determine which patients and practices may benefit most from primary care intervention. Design Observational study Setting Emergency departments attended by residents of the London borough of Brent Participants Patients with sickle cell disease registered with a general practitioner (GP) in the borough of Brent Main outcome measures Analysis of admissions between January 2008 and July 2010 that included length of stay (average and <2 days versus ≥2 days) by age group and registered GP practice. Results Thirty six percent of sickle cell disease admission spells resulted in a length of stay of less than two days. Seventy four percent of total bed days are associated with patients with more than one admission during the period of analysis, i.e. multiple admissions. Two general practices in Brent were identified as having the highest number of patients admitted to the emergency department for sickle cell crisis and may benefit most from primary care intervention. Discussion Patients with short length of stay and multiple admissions may be potentially amenable to primary care intervention. The practices which have the highest numbers of sickle cell disease patients who frequently seek emergency care will be earmarked for an education intervention designed to help further engage general practitioners in the care and management of their sickle cell patients.

Health disparities and community participation in England.

HEALTH disparities have been a longstanding feature of England’s National Health Service (NHS). In particular, socioeconomic and ethnic disparities remain in England despite numerous initiatives to abolish them (Department of Health, 2003). For example, people from lower socioeconomic groups and from nonwhite ethnic groups have a higher prevalence of chronic diseases such as diabetes and hypertension, poorer control of risk factors, and worse health outcomes than patient from more affluent groups and white European descent (Millett et al., 2007, 2009). These health disparities are the end result of complex, wide-ranging societal, healthcare-related and individual factors. People who experience poverty, material disadvantage, poor housing, lower educational achievement, unemployment or insecure employment, or homelessness are more likely to suffer poorer health outcomes and an earlier death than the rest of the population. Hence,

A Mars Bar is Not an Adequate Fatty Meal - A Comparison With Calogen

A prospective study was performed to compare the contractility of the gall bladder ultrasonically after ingestion of a 65 g Mars bar or 60 ml of Calogen. Using a repeated measure design, 27 healthy subjects were studied fasting and at 10 min intervals after ingestion of the fatty meal. Results show that there is a significant difference between Mars bar and Calogen (ANOVA, P < or = 0.01), with Calogen producing greater gall bladder contraction overall, and that the ejection fraction is greatest at 40 min (t = 2.23, P < or = 0.01). It is suggested that 60 ml of Calogen is used as the standard fatty meal to assess gall bladder contractility and that the patient is rescanned 40 min post fatty meal.

General health checks may not reduce morbidity or mortality but do increase the number of new diagnoses.

Commentary on: Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, et al . General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2012;10:CD009009. The burden of non-communicable disease such as cardiovascular disease, type 2 diabetes and kidney disease is increasing worldwide.1 These diseases all share risk factors that include smoking, hypertension, obesity, physical inactivity and hyperglycaemia. Their prevention, early identification and effective management could have major public health and economic benefits, and this has led to renewed interest …

How primary care can contribute to good mental health in adults

Abstract The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels – as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers.

Evaluating case studies of community-oriented integrated care

Abstract This paper summarises a ten-year conversation within London Journal of Primary Care about the nature of community-oriented integrated care (COIC) and how to develop and evaluate it. COIC means integration of efforts for combined disease-treatment and health-enhancement at local, community level. COIC is similar to the World Health Organisation concept of a Community-Based Coordinating Hub – both require a local geographic area where different organisations align their activities for whole system integration and develop local communities for health. COIC is a necessary part of an integrated system for health and care because it enables multiple insights into ‘wicked problems’, and multiple services to integrate their activities for people with complex conditions, at the same time helping everyone to collaborate for the health of the local population. The conversation concludes seven aspects of COIC that warrant further attention.

Improving outcomes for patients discharged early using a home assessment scheme

Abstract Background With increased delayed discharges from acute NHS hospitals, especially for older patients, solutions like the ‘Discharge to Assess’ (D2A) scheme aim to facilitate quicker discharge and improve experiences for patients and carers. Setting This report examines the quality process from the patient perspective of the D2A scheme implemented in a London Northwest Healthcare NHS Trust (LNWHT). A retrospective audit was conducted using the first cohort of patients discharged through this pilot scheme from April to July 2017. Question A brief study to explore patient views of their experience of the D2A scheme. Methods An opportunistic audit comprised of brief telephone interviews with patients following discharge from hospital through the D2A scheme. Results 30 patients who had been discharged with the D2A scheme, agreed to participate. Overall, patients were positive about their experience and valued the support and services provided. However, there were concerns on the issue of communication. The scheme effectiveness from the patient’s perspective improved over the duration of the evaluation. Discussion Patients’ views about their experiences changed over time, which included patients’ perceptions of the discharge process, patients’ expectations and the way in which they were able to access services.

Key priority areas for patient safety improvement strategy in Libya: a protocol for a modified Delphi study

Introduction Patient safety is a global public health problem. Estimates and size of the problem of patient safety in low-income and developing countries are scarce. A systems approach is needed for ensuring that patients are protected from harm while receiving care. The primary objective of this study will be to use a consensus-based approach to identify the key priority areas for patient safety improvement in Libya as a developing country. Design A modified Delphi study. Methods and analysis A three-phase modified Delphi study will be conducted using an anonymous web-based questionnaires. 15 international experts in the field of patient safety will be recruited to prioritise areas of patient safety that are vital to developing countries such as Libya. The participants will be given the opportunity to rank a list of elements on five criteria. The participants will also be asked to list five barriers that they believe hinder the implementation of patient safety systems. Descriptive statistics will be used to evaluate consensus agreement, including percentage agreement and coefficient of variation. Kendall’s coefficient of concordance will be used to evaluate consensus across all participants. Ethics and dissemination Ethical approval has been granted from Imperial College Research Ethics Committee (ICREC: 16IC3598). The findings of the study will be published in a PhD thesis. A manuscript will also be prepared for publication in a high-impact peer-reviewed journal describing the Delphi process and the findings of the study.