Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs
An electronic referral system including consultant-led triage and an advanced oral surgery service in primary care results in fewer people requiring oral surgery in hospital. It comes at a lower overall cost than the previous arrangement. About two-thirds of patients could be treated safely in enhanced primary settings rather than hospital.
This NIHR-funded study implemented several changes, an electronic referral system which standardised and improved the level of information provided in refer...
Self-care support for children with long-term conditions may reduce emergency costs
Helping children and parents to manage long-term conditions like asthma may reduce their need for emergency care, and is unlikely to reduce children’s quality of life.
This NIHR review found that structured professional help with self-care, including online support, provision of care plans, case management and face-to-face education, was linked to small increases in quality of life scores and fewer emergency department visits. However, there was no clear evidence that supported self-care ...
Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall.
The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either.
The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the...
Study raises questions about NHS “weekend effect”
The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness.
Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data.
Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate...
What works to support residents’ health in care homes and why
Long-term relationships and joint working between community health practitioners and care homes are the keys to improving appropriate hospital admissions and access to medications. Additional payments for GPs, jointly agreed protocols, clear role specifications and structured systems have impact only if they trigger and sustain collaborative working.
This realist evaluation in 12 English care homes for older people explored contexts for ‘relational working’ in three service delivery...
Wider stakeholder involvement could overcome resistance to modernising healthcare services
Among principles that can help when decommissioning out-dated, unsafe or poor value services are clear leadership and transparency about the reason for change with patients, clinicians and local communities.
Modernising healthcare often involves reducing, replacing and removing services. This is called decommissioning and the task varies with the local context.
This NIHR-funded study reviewed previous research and conducted interviews and surveys. Case studies showed consistent problems across...
Financial incentives do not increase attendance for diabetic eye screening
Two types of financial incentives are not effective at increasing attendance at eye screening for people with diabetes who do not regularly attend screening. Surprisingly, financial incentives may even reduce the numbers of people attending screening.
Retinopathy is a type of eye disease common to people with diabetes. Sight deteriorates only in the later stages and early diagnosis and treatment can prevent blindness. Annual eye screening is offered for people with diabetes but take-up could be...
Specialist hip fracture services linked to fewer deaths in South Central region
Following a hip fracture, nurse-led fracture liaison services or specialist consultant (orthogeriatrician) input both reduce deaths. They did not reduce the small number of people having a second hip fracture within two years of the first. Both models of care were cost effective, although the orthogeriatric model was favoured.
Despite national guidance recommending both use of a fracture liaison service and orthogeriatric model of care, variation exists and some hospitals have neither.
General surgery is mostly safe during pregnancy
Routine data from English hospitals show that general surgery during pregnancy, such as removing the appendix or gallbladder, does not commonly harm mother or baby. This suggests that surgery in pregnant women is generally safe, but that mothers could be provided with more specific estimates of the risks.
This large observational study assessed the “real world” outcomes of nearly 6.5 million pregnancies at hospitals in England over a 10-year period.
Women who had surgery during pre...
A third of people with dementia have treatable vision problems
New data shows that around a third of people with dementia have serious vision problems, such as cataracts or short sightedness, more than the general population of that age. Levels are higher still for people with dementia in care homes – about half have vision problems.
Yet this study showed that many of the people with dementia and vision impairment had not received the right treatment. This often involves simple measures. For many, spectacles could have improved poor sight. A quarter ...