Month: November 2018

Prescribing cannabis based drugs: response from NICE and Health Education England

Post author By Sarah Woodhall
Post date November 27, 2018

I thought I would include this response from NICE and HEE as it is an important message. Click the link below to access the letter or read it below.

https://www.bmj.com/content/363/bmj.k4940

Further to Hamilton’s recommendation that general practitioners consult Google Scholar and ask their colleagues if they are unsure about prescribing cannabis,1 we write to remind readers in England that they have 24/7 access to reliable sources of evidence to inform clinical decisions.

The National Institute for Health and Care Excellence’s evidence search (https://www.evidence.nhs.uk) provides access to authoritative evidence on health, social care, and public health. It focuses on synthesised secondary evidence, including content from over 800 sources, including the British National Formulary, Clinical Knowledge Summaries, SIGN, the Cochrane Library, the royal colleges, Public Health England, and GOV.UK. Information and knowledge specialists at NICE add further good quality systematic reviews. This service is openly available to everyone in the UK; here you will find reviews on the use of cannabis in treatment of epilepsy, neuropathic pain, fibromyalgia, HIV/AIDS, and asthma.

Healthcare staff in England can access a vital, core collection of healthcare databases and full text journals for no charge at https://hdas.nice.org.uk. Purchased by Health Education England on behalf of the NHS in England, these are provided online in partnership with NICE. You simply need an NHS OpenAthens account. Register at https://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases/OpenAthens.

NHS funded librarians and knowledge specialists are skilled in helping colleagues find information and search for evidence. They can offer summarised evidence searches and help teams keep up-to-date.

Health is a knowledge industry. We encourage practices to contact their local healthcare library. Check http://hlisd.org for details. Health Education England is committed to work with NHS organisations to ensure that all staff can access knowledge for healthcare23 and benefit from the expertise of healthcare librarians. We know that only a third of Clinical Commissioning Groups currently have such arrangements in place for their staff and member practices. For advice on improving your organisation’s access to knowledge services please contact your regional Health Education England library lead.3

economic evaluation Licensing Planning

Effects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trial

Post author By Sarah Woodhall
Post date November 23, 2018

Snooks H, Bailey-Jones K, Burge-Jones D, et alEffects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trialBMJ Qual Saf Published Online First: 05 November 2018. doi: 10.1136/bmjqs-2018-007976

Click here to view this article

Aim We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care.
Methods Randomised stepped wedge trial with 32 general practices in one Welsh health board. The intervention comprised: PRISM software; practice-based training; clinical support through two ‘general practitioner (GP) champions’ and technical support. The primary outcome was emergency hospital admissions.
Results Across 230 099 participants, PRISM implementation increased use of health services: emergency hospital admission rates by 1 % when untransformed (while change in log-transformed rate ΔL=0.011, 95% CI 0.010 to 0.013); emergency department (ED) attendance rates by untransformed 3 % (while ΔL=0.030, 95% CI 0.028 to 0.032); outpatient visit rates by untransformed 5 % (while ΔL=0.055, 95% CI 0.051 to 0.058); the proportion of days with recorded GP activity by untransformed 1 % (while ΔL=0.011, 95% CI 0.007 to 0.014) and time in hospital by untransformed 3 % (while ΔL=0.029, 95% CI 0.026 to 0.031). Thus NHS costs per participant increased by £76 (95% CI £46 to £106).
Conclusions Introduction of PRISM resulted in a statistically significant increase in emergency hospital admissions and use of other NHS services without evidence of benefits to patients or the NHS.

Library

New Journals Available to Public Health Staff

Post author By Sarah Woodhall
Post date November 20, 2018

This an update about the PHE journal licence extension to local authority public health teams.

The current licences expire in December 2018. We are extending the licences for a further year, the new expiry date being 31 December 2019.

Click the following link to access all the PHE electronic journals you have free access to. You will need an Athens username to access these journals. Contact Sarah Woodhall for help.

http://search.ebscohost.com/login.aspx?authtype=athens&profile=eds&groupid=main

From January 2019 there are some new additions to the content, including:

Lancet Respiratory Medicine

Lancet Psychiatry

Lancet Gastroenterology and Hepatology

Chest

New Scientist

Wiley Medical and Nursing Collection – over 400 journals

Springer Nature – all Nature titles and package of Springer titles

Healthy Settings Licensing Long-Term Conditions Mortality Nutrition Obesity Oral Health Physical Activity Planning Public Health Advice to NHS Commissioners

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Post author By Sarah Woodhall
Post date November 5, 2018

Steel, et al. Lancet 2018; 392: 1647–61

Click here to view this systematic review

Background

Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.

Methods

We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.

Findings

The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer’s disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health.

Interpretation

These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response.