Prescribing practice: an overview of the principles

2021 ◽  
Vol 30 (17) ◽  
pp. 1016-1022
Author(s):  
Aby Mitchell ◽  
Reuben Pearce
Keyword(s):  
Hospital Admissions ◽  
Healthcare Services ◽  
Valuable Resource ◽  
Long Term Conditions ◽  
Legal Principles ◽  
Nurse Prescribing ◽  
Prescribing Practice ◽  
Hospital Stays

Nurse prescribing has become a well-established aspect of advanced clinical practice working alongside key NHS principles and drivers to address the increasing complexities in patient care and the demands on the health service. Prescribing practice is governed by ethical and legal principles to ensure a holistic patient-centred approach. It has been recognised as a valuable resource that could effectively transform healthcare services to reduce hospital admissions and long hospital stays and improve the quality of life for patients with long-term conditions and multiple comorbidities. This article will provide an overview of prescribing practice.

scholarly journals Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

2021 ◽  
pp. BJGP.2021.0345
Author(s):  
Hassan Awan ◽  
Faraz Mughal ◽  
Tom Kingstone ◽  
Carolyn A Chew-Graham ◽  
Nadia Corp
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Emotional Distress ◽  
Help Seeking ◽  
South Asians ◽  
Qualitative Studies ◽  
Long Term Conditions ◽  
Help Seeking Behaviour

People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality compared to people with physical conditions alone. South Asians (SAs) are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. SAs are less likely to recognise symptoms which may represent mental health problems. To explore how people of SA origin with LTCs understand, experience and seek help for emotional distress, depression and anxiety. Systematic review of qualitative studies exploring emotional distress in SAs with diabetes or coronary heart disease, within primary and community care settings worldwide. Comprehensive searches of eight electronic databases from inception to 1st September 2021. Data extracted included study characteristics, and understanding, experience and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The CASP checklist for qualitative studies was used to assess quality of papers, and GRADE-CERQual used to determine the overall strength of evidence. Twenty one studies from 3,165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension,’ and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and gender differences. Help-seeking behaviour: self-management, seeking help from family, friends, and faith, and inadequate clinical support. This review provides a greater understanding of SAs’ conceptualisation of emotional distress in the context of LTCs, to support improvement in its recognition and management.

Care of adults with long-term conditions

2020 ◽  
pp. 597-676
Keyword(s):  
Varicose Veins ◽  
Healthcare Providers ◽  
Motor Neurone ◽  
Chronic Obstructive ◽  
Long Term Conditions ◽  
Obstructive Pulmonary Disease ◽  
Lower Back ◽  
Respiratory Conditions

Multiple comorbidities necessitate care from a number of healthcare providers. Continuity of care is important for both patient satisfaction and quality of life. This chapter outlines primary care for adults with a variety of conditions, including osteoarthritis, rheumatoid arthritis, lower back pain, asthma and acute asthma, and stable and chronic obstructive pulmonary disease. It covers drugs commonly used in the treatment of respiratory conditions, including long-term oxygen and nebulizers. It then goes on to cover coronary heart disease, angina, hypertension, cardiac rehabilitation, heart failure, abnormal cardiac rhythms and atrial fibrillation, patients on anticoagulant therapies, and drugs used in cardiovascular diseases. The chapter also includes information on anaemia, varicose veins, diabetes, multiple sclerosis, motor neurone disease, and Parkinson’s disease.

The context of healthcare

2020 ◽  
pp. 1-34
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Northern Ireland ◽  
Healthcare Services ◽  
Health Profile ◽  
Long Term Conditions ◽  
Key Concepts ◽  
The Uk

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

Teamwork

2018 ◽  
pp. 587-594
Author(s):  
Maria Flynn ◽  
Dave Mercer
Keyword(s):  
Health Professionals ◽  
Healthcare Setting ◽  
Healthcare Services ◽  
Health Condition ◽  
Illness Episode ◽  
Wide Range ◽  
Working Together ◽  
Effective Organization

The importance of teamworking has been long established in healthcare, with nurses working both as part of a nursing team and as members of the wider multidisciplinary team. The effective organization and delivery of healthcare services depends upon a wide range of health professionals, patients, families, and carers working together to achieve the best health outcomes and quality of life. Whether healthcare is necessary for an acute illness episode, helping someone with a long-term health condition achieve an acceptable level of function, or supporting a person who is dying, placing people at the centre of care decisions demands effective teamworking. Understanding the nature and characteristics of teams can help nurses to work effectively and uphold professional caring values when working with people in any healthcare setting. This chapter outlines the key definitions and characteristics of teamworking.

scholarly journals Effect of the COVID-19 lockdown on disease recognition and utilisation of healthcare services in the older population in German: a cross-sectional study

2020 ◽  
Author(s):  
Bernhard Michalowsky ◽  
Wolfgang Hoffmann ◽  
Jens Bohlken ◽  
Karel Kostev
Keyword(s):  
Hospital Admissions ◽  
Healthcare Services ◽  
Routine Care ◽  
Cross Sectional Study ◽  
Age Group ◽  
Sectional Study ◽  
Long Term Effects ◽  
Older Population ◽  
Cross Sectional

Abstract Background There is little evidence about the utilisation of healthcare services and disease recognition in the older population, which was urged to self-isolate during the COVID-19 lockdown. Objectives We aimed to describe the utilisation of physician consultations, specialist referrals, hospital admissions and the recognition of incident diseases in Germany for this age group during the COVID-19 lockdown. Design Cross-sectional observational study. Setting 1,095 general practitioners (GPs) and 960 specialist practices in Germany. Subjects 2.45 million older patients aged 65 or older. Methods The number of documented physician consultations, specialist referrals, hospital admissions and incident diagnoses during the imposed lockdown in 2020 was descriptively analysed and compared to 2019. Results Physician consultations decrease slightly in February (−2%), increase before the imposed lockdown in March (+9%) and decline in April (−18%) and May (−14%) 2020 compared to the same periods in 2019. Volumes of hospital admissions decrease earlier and more intensely than physician consultations (−39 versus −6%, respectively). Overall, 15, 16 and 18% fewer incident diagnoses were documented by GPs, neurologists and diabetologists, respectively, in 2020. Diabetes, dementia, depression, cancer and stroke were diagnosed less frequently during the lockdown (−17 to −26%), meaning that the decrease in the recognition of diseases was greater than the decrease in physician consultations. Conclusion The data suggest that organisational changes were adopted quickly by practice management but also raise concerns about the maintenance of routine care. Prospective studies should evaluate the long-term effects of lockdowns on patient-related outcomes.

scholarly journals Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathleen Morrisroe ◽  
Wendy Stevens ◽  
Joanne Sahhar ◽  
Gene-Siew Ngian ◽  
Nava Ferdowsi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systemic Sclerosis ◽  
Ambulatory Care ◽  
Clinical Characteristics ◽  
Hospital Admissions ◽  
Healthcare Services ◽  
Healthcare Resource Utilization ◽  
Digital Ulcers ◽  
Diffuse Disease

Abstract Background To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. Methods Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1–5 DUs, moderate 6–10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008–2015. Healthcare cost determinants were estimated using logistic regression. Results Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 ± 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p < 0.001), anti-Scl-70 antibody (18.9% vs 9.3%, p < 0.001), and a younger age at SSc onset (43.6 ± 13.9 vs 48.8 ± 14.0 years, p < 0.001) in addition to reduced health-related quality of life (HRQoL) measured by the SF-36 but without a significant impact on survival. SSc patients with a history of a DU utilized significantly more healthcare resources per annum than those without a DU, including hospitalizations, ED presentation, and ambulatory care services. Total healthcare services, excluding medications, were associated with an annual excess cost per DU patient of AUD$12,474 (8574-25,677), p < 0.001, driven by hospital admission and ED presentation costs. Conclusion DUs place a large burden on the patient and healthcare system through reduced HRQoL and increased healthcare resource utilization and associated cost.

Patients' experiences of nurse case management in primary care: a meta-synthesis

2017 ◽  
Vol 23 (5) ◽  
pp. 420 ◽  
Author(s):  
Anna Askerud ◽  
Jenny Conder
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Case Management ◽  
Research Question ◽  
Health Conditions ◽  
Long Term Conditions ◽  
Nurse Case Management ◽  
Primary Health

The health system in New Zealand and Australia requires health practitioners to prepare for the challenge of long-term conditions. Wagner’s 1998 Chronic Care Model advocates a move away from the traditional acute model of primary health care to a model that addresses the long-term episodic nature of chronic disease. Nurse case management has been developed over the last 2 decades as a means to coordinate health services for people with long-term conditions. This meta-synthesis combines the results of 15 qualitative research studies that have a similar research question regarding peoples’ perceptions of nurse case management. The research synthesises the experiences of people with long-term conditions on the quality of care under a nurse case management model of primary health care. Over 1000 people were represented across the studies, and the results suggest that people had a high degree of confidence and trust in their nurse case manager, were better able to manage their health conditions with nurse case management support, and had better access to appropriate health care. This research suggests that nurse case management is an effective model of care and may contribute to improved quality of life and better health care for those with long-term health conditions.

scholarly journals P.011 OnabotulinumtoxinA, quality of life, health resource utilization, and work productivity in chronic migraine: interim results from PREDICT

2019 ◽  
Vol 46 (s1) ◽  
pp. S16
Author(s):  
G Boudreau ◽  
WJ Becker ◽  
C Graboski ◽  
M Ong-Lam ◽  
I Finkelstein ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Resource Utilization ◽  
Hospital Admissions ◽  
Diagnostic Testing ◽  
Work Productivity ◽  
Healthcare Resource Utilization ◽  
Related Quality ◽  
Health Related

Background: We assessed long-term health-related quality of life (HRQoL) and functioning in adults receiving onabotulinumtoxinA for CM. Methods: Interim analysis of multicentre, prospective, observational study in adults naïve to botulinum toxin (NCT02502123). Mean change from baseline in Migraine-Specific Quality of Life (MSQ) score (primary); healthcare resource utilization (HRU) and work productivity (secondary) assessed in patients receiving 4 of 7 onabotulinumtoxinA treatments (Tx4; ~10 months). Results: Across treatments (baseline, n=196, post-Tx2, n=173, post-Tx4, n=137), the mean (SD) between-session interval and onabotulinumtoxinA dose was 13.1 weeks and 170.4 (17.2) U, respectively. MSQ scores increased significantly (P&lt;0.0001) (baseline to post-Tx4; all role function domains). Patient percentages declined from baseline to post-Tx2 and post-Tx4 for emergency room visits (17.3%; 9.3%; 6.6%), hospital admissions (3.6%; 2.9%; 1.5%), and headache-related diagnostic testing (35.9%; 15.9%; 8.1%). The percentages of patients employed at baseline (73.5%) and post-Tx4 (72.3%) were similar. Hours worked increased slightly from baseline to post-Tx4 (28.0 [SD=15.4]; 29.4 [SD=16.0]). Headache-related missed work hours decreased (5.9 [SD=9.5]; 2.5 [SD=5.9]). Patients reported less headache-related impact on work productivity from baseline to post-Tx4 (5.4 [SD=2.1] vs 3.9 [SD=2.6]) and ability to perform daily activities (6.1 [SD=2.1] vs 4.2 [SD=2.8]). Conclusions: OnabotulinumtoxinA for CM improved HRQoL and work productivity and reduced HRU.

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