scholarly journals Multimorbidity: the case for prevention

2020 ◽  
pp. jech-2020-214301
Author(s):  
Anna Head ◽  
Kate Fleming ◽  
Chris Kypridemos ◽  
Jonathan Pearson-Stuttard ◽  
Martin O’Flaherty

Multimorbidity is of increasing concern for healthcare systems globally, particularly in the context of ageing population structures, such as in the European Union and the UK. Although there is growing attention on developing strategies to manage the health and healthcare burden of older patients with multimorbidity, little research or policy focus has been placed on how to best prevent the development of multimorbidity in future generations. In this research agenda piece, we argue for a shift from a sole focus on the management of multimorbidity in old age to a multimorbidity agenda that considers prevention and management throughout the life-course.

2018 ◽  
Vol 36 (4) ◽  
pp. 493-500 ◽  
Author(s):  
Abigail Moore ◽  
Caroline Croxson ◽  
Sara McKelvie ◽  
Dan Lasserson ◽  
Gail Hayward

Abstract Background The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home. Objectives To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective. Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach. Results GPs’ key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity. Conclusion GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.


Author(s):  
Tracey A. Elliott

This chapter explores the significant problem of healthcare fraud in Europe, which in the UK alone is estimated at £1.27 billion a year or more than 30% of the European Union healthcare budgets. It emphasizes the difficulties of identifying the predominant “European approach” on the ethical, definitional, and operational challenges that make healthcare fraud difficult to define, identify, police, and prevent. It also describes different healthcare fraud problems in European countries that vary in historical, cultural, and political circumstances. This chapter discusses the significance of how European states manage the financing of their healthcare systems and payment of healthcare professionals as it affects the forms of abusive conduct that might occur. It also mentions the UK, Ireland, Italy, Spain, Portugal, and the Nordic Countries as states vulnerable to procurement corruption as stated by Transparency International.


2011 ◽  
Vol 8 (2) ◽  
pp. 35-38 ◽  
Author(s):  
Vicky Banks ◽  
Geoff Searle ◽  
Rachel Jenkins

The National Health Service (NHS) serves the UK through four devolved organisations for England, Scotland, Wales and Northern Ireland. It is one of the largest public healthcare systems in the world, universal and free at the point of delivery. Its key challenge is to maintain this approach within tight financial constraints, while embracing new technologies, treatments and styles of service delivery, as well as meeting the health needs of an ageing population.


Author(s):  
Jan Astermark ◽  
Cihan Ay ◽  
Manuela Carvalho ◽  
Roseline D'Oiron ◽  
Philippe De Moerloose ◽  
...  

Introduction: A second peak of inhibitors has been reported in patients with severe haemophilia A (HA) aged >50 years in the UK.1 The reason for this suggested breakdown of tolerance in the ageing population is unclear, as is the potential impact of regular exposure to the deficient factor by prophylaxis at higher age. No data on haemophilia B (HB) has ever been reported. Aim: The ADVANCE Working Group investigated the incidence of late-onset inhibitors and the use of prophylaxis in patients with HA and HB aged ≥40 years. Methods: A retrospective, observational, cohort, survey-based study of all patients aged ≥40 years with HA or HB treated at an ADVANCE HTC. Results: Information on 3,095 people aged ≥40 years with HA or HB was collected. Of the 2,562 patients with severe HA, the majority (73% across all age groups) received prophylaxis. In patients with severe HA, the inhibitor incidence per 1,000 treatment years was 2.37 (age 40–49), 1.25 (age 50–59) and 1.45 (age 60+). Overall, the inhibitor incidence was greatest in those with moderate HA (5.77 (age 40–49), 6.59 (age 50–59) and 4.69 (age 60+) and the majority of inhibitor cases were preceded by a potential immune system challenge. No inhibitors in patients with haemophilia B were reported. Conclusion: Our data do not identify a second peak of inhibitor development in older patients with haemophilia. Prophylaxis may be beneficial in older patients with severe, and possibly moderate HA, to retain a tolerant state at higher age.


2014 ◽  
Vol 10 (3) ◽  
pp. 249-261 ◽  
Author(s):  
Tessa Sanderson ◽  
Jo Angouri

The active involvement of patients in decision-making and the focus on patient expertise in managing chronic illness constitutes a priority in many healthcare systems including the NHS in the UK. With easier access to health information, patients are almost expected to be (or present self) as an ‘expert patient’ (Ziebland 2004). This paper draws on the meta-analysis of interview data collected for identifying treatment outcomes important to patients with rheumatoid arthritis (RA). Taking a discourse approach to identity, the discussion focuses on the resources used in the negotiation and co-construction of expert identities, including domain-specific knowledge, access to institutional resources, and ability to self-manage. The analysis shows that expertise is both projected (institutionally sanctioned) and claimed by the patient (self-defined). We close the paper by highlighting the limitations of our pilot study and suggest avenues for further research.


2019 ◽  
Author(s):  
Sneha Barai

UNSTRUCTURED The UK General Medical Council (GMC) explicitly states doctors have a duty to ‘contribute to teaching and training…by acting as a positive role model’. However, recent studies suggest some are not fulfilling this, which is impacting medical students' experiences and attitudes during their training. As such, doctors have a duty to act as role models and teachers, as specified by the GMC, which it seems are not currently being fulfilled. This would improve the medical students’ learning experiences and demonstrate good professional values for them to emulate. Therefore, these duties should be as important as patient care, since this will influence future generations.


This book provides the first comprehensive analysis of the withdrawal agreement concluded between the United Kingdom and the European Union to create the legal framework for Brexit. Building on a prior volume, it overviews the process of Brexit negotiations that took place between the UK and the EU from 2017 to 2019. It also examines the key provisions of the Brexit deal, including the protection of citizens’ rights, the Irish border, and the financial settlement. Moreover, the book assesses the governance provisions on transition, decision-making and adjudication, and the prospects for future EU–UK trade relations. Finally, it reflects on the longer-term challenges that the implementation of the 2016 Brexit referendum poses for the UK territorial system, for British–Irish relations, as well as for the future of the EU beyond Brexit.


2019 ◽  
Vol 9 (1) ◽  
pp. 65-93 ◽  
Author(s):  
Alberto Arenal ◽  
Claudio Feijoo ◽  
Ana Moreno ◽  
Cristina Armuña ◽  
Sergio Ramos

Purpose Academic research into entrepreneurship policy is particularly interesting due to the increasing relevance of the topic and since knowledge about the evolution of themes in this field is still rather limited. The purpose of this paper is to analyse the key concepts, topics, trends and shifts that have shaped the entrepreneurship policy research agenda during the period 1990–2016. Design/methodology/approach This paper uses text mining techniques, cluster analysis and complementary bibliographic data to examine the evolution of a corpus of 1,048 academic papers focused on entrepreneurship-related policies and published during the period 1990–2016 in ten relevant journals. In particular, the paper follows a standard text mining workflow: first, as text is unstructured, content requires a set of pre-processing tasks and then a stemming process. Then, the paper examines the most repeated concepts within the corpus, considering the whole period 1990–2016 and also in five-year terms. Finally, the paper conducts a k-means clustering to divide the collection of documents into coherent groups with similar content. The analyses in the paper also include geographical particularities considering three regional sub-corpora, distinguishing those articles authored in the European Union (EU), the USA and South and Eastern Asia, respectively. Findings Results of the analysis show that inclusion, employment and regulation-related papers have largely dominated the research in the field, evolving from an initial classical approach to the relationship between entrepreneurship and employment to a wider, multidisciplinary perspective, including the relevance of management, geographies and narrower topics such as agglomeration economics or internationalisation instead of the previous generic sectorial approaches. The text mining analysis also reveals how entrepreneurship policy research has gained increasing attention and has become both more open, with a growing cooperation among researchers from different affiliations, and more sophisticated, with concepts and themes that moved the research agenda forward, closer to the priorities of policy implementation. Research limitations/implications The paper identifies main trends and research gaps in the field of entrepreneurship policy providing actionable knowledge by presenting the spectrum of both over-explored and understudied research themes in the field. In practical terms the results of the text mining analysis can be interpreted as a compass to navigate the entrepreneurship policy research agenda. Practical implications The paper presents the heterogeneity of topics under research in the field, reinforcing the concept of entrepreneurship as a multidisciplinary and dynamic domain. Therefore, the definition and adoption of a certain policy agenda in entrepreneurship should consider multiple aspects (needs, objectives, stakeholders, expected outputs, etc.) to be comprehensive and aligned with its complexity. In addition, the paper shows how text mining techniques could be used to map the research activity in a particular field, contributing to the challenge of linking research and policy. Originality/value The exploratory nature of text mining allows us to obtain new knowledge and reveals hidden patterns from large quantities of documents/text data, representing an opportunity to complement other qualitative reviews. In this sense, the main value of this paper is not to advise on the future configuration of entrepreneurship policy as a research topic, but to unwrap the past by unveiling how key themes of the entrepreneurship policy research agenda have emerged, evolved and/or declined over time as a foundation on which to build further developments.


2021 ◽  
pp. 1-12
Author(s):  
Ben Hannigan

Abstract Wales is a small country, with an ageing population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the UK. This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.


Author(s):  
Samantha Cruz Rivera ◽  
Barbara Torlinska ◽  
Eliot Marston ◽  
Alastair K. Denniston ◽  
Kathy Oliver ◽  
...  

Abstract Background The UK’s transition from the European Union creates both an urgent need and key opportunity for the UK and its global collaborators to consider new approaches to the regulation of emerging technologies, underpinned by regulatory science. This survey aimed to identify the most accurate definition of regulatory science, to define strategic areas of the regulation of healthcare innovation which can be informed through regulatory science and to explore the training and infrastructure needed to advance UK and international regulatory science. Methods A survey was distributed to UK healthcare professionals, academics, patients, health technology assessment agencies, ethicists and trade associations, as well as international regulators, pharmaceutical companies and small or medium enterprises which have expertise in regulatory science and in developing or applying regulation in healthcare. Subsequently, a descriptive quantitative analyses of survey results and directed thematic analysis of free-text comments were applied. Results Priority areas for UK regulatory science identified by 145 participants included the following: flexibility: the capability of regulations to adapt to novel products and target patient outcomes; co-development: collaboration across sectors, e.g. patients, manufacturers, regulators, and educators working together to develop appropriate training for novel product deployment; responsiveness: the preparation of frameworks which enable timely innovation required by emerging events; speed: the rate at which new products can reach the market; reimbursement: developing effective tools to track and evaluate outcomes for “pay for performance” products; and education and professional development. Conclusions The UK has a time-critical opportunity to establish its national and international strategy for regulatory science leadership by harnessing broader academic input, developing strategic cross-sector collaborations, incorporating patients’ experiences and perspectives, and investing in a skilled workforce.


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