The NHS Health Check is changing again. Since the beginning of April 2013, practice nurses have been expected to raise the issue of dementia when seeing patients aged 65-74. But why (I can hear you ask)? Surely we have enough to do! This article explains why dementia matters, and sets out your role in the NHS Health Check.
ENHANCE HF™: optimising the management of heart failure in primary care
Heart failure (HF) imposes a significant burden across the UK, both for patients and the NHS. Optimal management of HF could improve patient outcomes and reduce costs for clinical commissioning groups (CCGs). HF is, however, complex to manage, and despite recent improvements there is evidence of a continuing lack of adherence to guideline recommendations. Enhance HF™ is a tool that supports GPs in optimising the management of HF due to left-ventricular systolic dysfunction to help deliver more costeffective care for patients in their practice.
The accuracy of GP blood pressure measurements compared with 24-hour ambulatory monitoring
We evaluated the accuracy and predictive value of conventional BP measurements performed by primary care physicians in comparison with ABPM in a cross-sectional study of hypertensive patients in primary healthcare. We found that conventional BP measurements are less accurate than 24-hour ABPM.
Cardiovascular morbidity and mortality in schizophrenia: implications for primary care
People with schizophrenia have substantial premature mortality compared to individuals without schizophrenia. They also have a wide range of co-morbidities and multiple physical health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic underrecognition and under-treatment of cardiovascular disease, which may contribute to the increased mortality seen in this vulnerable patient group.
CVD and HIV patients
We highlight in this article some of the issues on HIV and cardiovascular disease (CVD) to assist primary healthcare practitioners to improve the health outcomes, particularly in relation to CVD, of their HIV patients.
Strategies to prevent chronic kidney disease progression based on risk assessment in primary care
Chronic kidney disease (CKD) is increasing worldwide. The aim of this study was to identify factors related to progression of chronic kidney disease in a primary care service. Risk factors for progression of CKD were: diabetes, hypertension, uncontrolled systolic pressure and basal creatinine.
Should high-intensity interval exercise be recommended for the prevention of long-term conditions?
There is evidence to show that high-intensity interval exercise (HIIE) can increase cardiorespiratory fitness, lower blood pressure, increase insulin sensitivity and reduce body fat. All these are important in preventing the development of type 2 diabetes and cardiovascular disease.
Understanding combined oral contraception
Formulations have evolved considerably since the combined oral contraceptive pill (COC) became available more than 50 years ago. Understanding the sex-steroid hormones in currently available COCs is essential, as it helps to indicate the combination with the greatest potential benefit for each woman.
In this new article, Dr Paula Briggs goes back to the basic structure of the COC to explain how to choose the right pill for the right woman at the right time.
The added benefits of combined hormonal contraception
The combined hormonal oral contraceptive pill (COC) has been available in the UK for the last 50 years. During this time, the dose of ethinyl estradiol has fallen from 100 mcg to 20-30 mcg, increasing patient acceptability and improving drug safety by reducing the risk of venous thromboembolism (VTE). At the same time, a number of non-contraceptive health benefits have emerged in association with combined hormonal contraception (CHC).
Protect and survive: fighting back against HPV
The human papillomavirus (HPV) is responsible for 99% of cervical cancers, and vaccines are now available that make it possible to protect girls before they become sexually active. However, vaccinating schoolgirls against a virus that is contracted through sexual contact is a controversial topic, provoking questions from young women and their parents. To encourage young women to accept this potentially life-saving vaccine, it is important that GPs and practice nurses are able to answer patients’ questions about HPV.
New approaches to managing risk of familial breast cancer
Women with a family history of breast cancer are increasingly proactive in seeking help. As a result, breast centres and cancer genetics departments have seen an increase in referrals. This has no doubt had repercussions for workload in primary care, especially given the updated guideline on familial breast cancer from the National Institute for Health and Care Excellence (NICE). These recommendations have lowered the threshold for genetic testing, and have introduced the possibility of chemoprevention with tamoxifen or raloxifene.
Gynaecology referrals: on the right track
Gynaecology rapid-access clinics allow prompt assessment by specialists of women with suspected gynaecological malignancy, with the aim of improving cancer outcomes and patient experience, and ultimately reducing mortality. However, the ability of trusts to assess and treat women within specified targets relies on appropriate referral from primary care. Without this, fast-track services become overwhelmed with women who could be assessed by a routine referral, potentially delaying the review of women with suspected malignancy and creating unnecessary patient anxiety.
