The updated NICE guideline on post-myocardial infarction care (CG 172) provides a benchmark for primary care. In this article, Ivan Benett and Jennifer Yung highlight the five key tasks for general practice in caring for someone who has suffered a heart attack.
A large amount of evidence points to the effectiveness of optimising primary care heart failure management in reducing referral to hospital and improving outcomes for patients. This article describes the changes made in a primary care practice that has resulted in measurable difference for the primary care team and their patients.
Chronic kidney disease (CKD) is now classified using a combination of estimated glomerular filtration rate (eGFR) and proteinuria measured by albumin:creatinine ratio (ACR). The aim is to more accurately define each patient’s risk of cardiovascular disease and worsening CKD, and to ensure that patients are monitored appropriately.
I hate being told what to do and usually I will do the opposite. So where on earth did I get the belief that I know what is right and that I must make sure I tell everyone what to do to stay healthy?
The first section of this supplement made the case to consider frailty from the perspective of a long-term condition. This and the next section explore what this means in terms of applying some of the well-developed models for the care of longterm conditions to people who are living with frailty. First, we examine how the highly evidence-based model of supported self-management might be applied to frailty.
Who should be treated with these new agents? When should patients be switched from warfarin or aspirin?
Dr Matthew Fay
GP and National Clinical Lead for Atrial Fibrillation, Westcliffe Medical Centre, Shipley
Dr Frances Akinwunmi
Consultant Pharmacist (Anticoagulation), Imperial College Healthcare NHS Trust
Ten per cent of the annual NHS budget is spent on medication, with about 75% of this is prescribed in primary care. Ensuring that this money really improves patients’ health is vitally important. As the population ages, more people require increasing numbers of medications for chronic conditions and a third of elderly patients are taking four drugs or more for a spectrum of conditions. But this creates a major challenge – as research reveals that fewer than half of these patients take their medicines as prescribed. How can this challenge be addressed? This new series will provide simple practical guidance on how to conduct an effective medication review for a spectrum of long-term cardiovascular conditions.
Swallowing really is a life or death matter. Nearly half of people who have had a stroke will initially experience difficulty swallowing. This is called dysphagia. In this article, we look at the anatomy and physiology of swallowing, what can go wrong in people who have had a stroke, and what can help. Explanations are given clearly, using simple language that you can use with patients and their family members.
“It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it.-(William Osler, Aequanimitas, Books and Men)
The new coalition government of the United Kingdom (UK) has announced plans to change the NHS radically in England. The Department of Health has published two important documents Equity and excellence: liberating the NHS and Liberating the NHS: commissioning for patients. The implications for primary and secondary care, and for local authorities, mental health services and community providers, will be enormous. The changes are taking place at a rapid pace and every manager and clinician in the NHS will need to keep abreast of developments as they will affect the way in which we all deliver services in the future.
What is important when a nurse and patient are together in a consultation? Most of us have had consultations where the discussion did not appear to achieve anything, while, on other occasions, both parties seemed to be working well together. This article looks at how to share the process of planning treatment with a patient to improve health outcomes; it examines what concordance is, and how to achieve it, looking at how this might work out in practice.