Practice-based commissioning – in which practices commission care directly – will be universal by December 2006. This means that it is no longer an option for practices to commission the care they need for their patients. We must either get involved and take control of this opportunity or allow someone else to do it for us. This may be our last chance to remain independent and to manage our practices rather than being managed by others. In this article, we look at what practice commissioning will involve and how it will affect practices and PCTs.
Implantable Cardioverter Defibrillators (ICDs)
Implantable Cardioverter Defibrillators (ICDs) have – quite literally – fired a major revolution in the management of patients at high risk for potentially life-threatening arrhythmias. More sophisticated than pacemakers, ICDs monitor the heart constantly, but only initiate an electrical signal when they detect an incorrect heart rhythm. ICDs can function as pacemakers for slow heart rates, but may also deliver high-energy electrical therapy for fast heart rates. In this article, we review how ICDs work, how they are used and what care we need to provide for patients who have had these devices implanted.
Preventing Retinopathy with Regular Screening and Effective Treatment
Diabetes is the leading cause of blindness in the UK in people of working age. Diabetic retinopathy occurs when blood vessels in the retina become blocked, leaky, or grow haphazardly. There are usually no obvious symptoms, making the condition difficult to detect until it is well advanced. However, irreparable damage has been done by this time. This article outlines the importance of screening for early detection of retinopathy, and reviews the targets set in the National Service Framework (NSF) for Diabetes Priorities document (2003) regarding annual retinal screening tests.
Glucose Monitoring in the Surgery – Which Test?
There are several blood tests that can be used to measure blood sugar levels, including random blood sugar, fasting blood sugar, glycosylated haemoglobin (HbA1C) and the glucose tolerance test (GTT). This article provides a ‘whistle-stop’ tour updating you on what information each of these tests provides, what test to use when and how to explain the procedures and results to your patients.
Editorial
All in all, it’s been a good year for primary care in the UK. Results from the first year of the Quality and Outcomes Framework (QOF) showed practices have performed much better than anyone expected in terms of delivering very high quality care. BJPCN is designed to help you keep hitting the challenging targets practice teams will be aiming for in the year ahead.
Which antihypertensives are best? Making sense of the ASCOT study
Newer’ antihypertensive therapy reduces cardiovascular events compared to ‘older’ drugs, according to the recently published Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm (ASCOT-BPLA). The results showed that antihypertensive therapy based on the calcium channel blocker amlodipine, with the ACE inhibitor perindopril added as required, reduced cardiovascular events compared with treatment based on the beta-blocker atenolol. In this article, we review what the findings mean for primary care management of high blood pressure and put them in perspective.
Back to Basics: Aspirin in CVD prevention
Faddy diets: fact or fiction?
An estimated two-thirds of the population are thinking about, or trying to lose weight at any time. To meet this demand, there is a growing range of commercial and ‘fad’ diets available but, unfortunately, very little research to indicate what works and what doesn’t. This article looks at some of the more popular fad and commercial diets you may be asked about in clinic, giving you the information you need to have a discussion about the pros and cons of different weight loss methods with your patients, to help them lose weight and keep it off. The key finding seems to be – if it sounds too good to be true, it probably is!
Venous leg ulcers
Chronic leg ulcers are a major health problem in the UK, affecting many older people and costing the NHS up to £600 million per year. Chronic leg ulcers are generally managed in primary care: more than 80% of chronic leg ulcers are cared for in the community. Healing rates are currently low and recurrence rates are higher than 67%. However, appropriate use of available treatments can reduce recurrence rates to between 20% and 30%. In this article, we review the causes of venous ulceration, how to spot the problem early and how to optimise leg ulcer healing.
Scoring QOF points for diabetes
IIn this, the fifth article in our series on the Quality and Outcomes Framework (QOF), we review how to score top points for diabetes. This is an area that has been managed almost wholly in Primary Care for many years. Virtually all practices now have a diabetes clinic, which generally has extensive nurse involvement – with many being nurse-led. Practices are doing extremely well in this area and many are achieving a very high percentage of points. Figures for practices in England showed that on average they scored 93.2% of the QOF points for diabetes. This article offers some pointers on how to keep up the good work.
Going for gold: reducing cardiovascular risk with physical activity
Physical activity reduces the risk of developing heart disease and lowers the risk of death and further events in patients with cardiovascular conditions. This article reviews the benefits of exercise and shares some of the strategies our team uses to help patients with heart disease increase their levels of physical activity and keep active after they have completed phase 3 cardiac rehabilitation.
Self blood glucose monitoring
Monitoring blood glucose levels is a central part of managing diabetes effectively. Inadequate monitoring can put a patient at risk of both short- and long-term complications. Maintaining near normal blood glucose levels helps to prevent immediate problems such as hypoglycaemia and hyperglycaemia and longer-term microvascular complications, including retinopathy, renal disease and neuropathy. There are many different ways in which diabetes can be monitored; this article focuses on self blood glucose monitoring.
