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Found 23 results
  1. News Article
    The NHS in England is set to have a major conditions strategy to help determine policy for the care of increasing numbers of people in England with complex and often multiple long-term conditions. Conditions covered by the strategy will include cardiovascular disease, chronic respiratory disease, dementia, mental health conditions, and musculoskeletal disorders. Cancer will also be included and will no longer have its own dedicated 10 year strategy. England’s health and social care secretary, Steve Barclay, told the House of Commons on 24 January that the strategy would build on measures in the NHS long term plan. Read full story (paywalled) Source: BMJ, 25 January 2023
  2. Content Article
    Recommendations Hip fracture teams should use quarterly governance meetings to review the quality and outcome of the care they provide. Where performance is significantly below average, units should formally discuss possible reasons for this within their regular MDT meeting, and plan a QI project to address it. Quarterly governance meetings should be taken as an opportunity for team members and trainees from all disciplines to make use of the NHFD website as a driver for QI; the new Quarterly Governance Tool is designed to help them do this. The NHFD recommends that governance meetings of surgical, orthogeriatric, anaesthetic, nursing, therapy and management leads should take place on at least a monthly basis. Monthly governance meetings should be used to plan appropriate QI interventions, and to monitor the impact of these using the real-time data reported in the NHFD run charts. Hip fracture teams should use their KPI caterpillar plots to identify better-performing neighbouring units, so they can share best practice and network with them in designing QI work. Hip fracture teams should use KPI 0 as a marker of initial care and a driver to improve the provision of local anaesthetic nerve blocks and fast-tracking of patients to an appropriate ward. Performance should be considered alongside the figures for their unit in the Anaesthesia run chart and Assessment benchmarking table. To help patients avoid further fragility fractures, hip fracture team governance meetings should review KPI 7 alongside their Bone Medication Table and arrangements for 120-day follow-up. Hip fracture teams should signpost patients, their families and carers to the NHFD website resources designed to help them understand their care and recovery following a hip fracture. Hip fracture teams should use monthly governance meetings to review their policies and protocols, and to compare these with those in other units as described in the Facilities Survey. Hip fracture teams should minimise inequalities in health care; specifically by reviewing whether support and information are provided in formats and languages appropriate to their patients.
  3. Content Article
    Making a decision about Dupuytren’s contracture Making a decision about carpal tunnel syndrome Making a decision about hip osteoarthritis Making a decision about knee osteoarthritis Making a decision about further treatment for atrial fibrillation Making a decision about cataracts Making a decision about glaucoma Making a decision about wet age-related macular degeneration
  4. Content Article
    In this paper, ARMA makes the following recommendations: Develop multidisciplinary, networked, personalised approaches to pain as standard. Develop more community-based approaches to pain. Everyone with chronic pain should be offered a holistic assessment of their symptoms in primary care reviewing the impact on their physical and mental health, their activities of daily living and their wellbeing, including the ability to work/study, and explore any underlying causes of or contributors to their pain. A public health approach is needed based on community need to design and target effective public health interventions to support those who have chronic pain to improve their health and their quality of life. Take a strategic, integrated population health approach to commissioning pain services ensuring money transcends organisational boundaries, focussed on the provision of a range of chronic pain support options and intervention allowing for personalisation. There should be early access to treatment for painful conditions to minimise pain becoming chronic, including rapid diagnosis, which is important to people. Integrated physical and mental health support for people with MSK pain conditions should be available and every CCG should include MSK chronic pain in IAPT for Long Term Conditions with staff who have joint expertise in both physical and mental health and understanding of chronic pain. Understand health inequalities, discuss and implement levers for change. Systems and services should allow equity in access, experience of using NHS services and equity of outcomes for all groups. Systems and services should be inclusive and culturally sensitivity. Social prescribing to provide supported self-management at scale. Every person with chronic pain should have access to peer support and be signposted to the patient organisations relevant to them. Healthcare professionals education and training to include understanding and management of pain and emphasise the personalised biopsychosocial approach and communications skills training to support them to have good conversations. Public education – including employers, public attitudes to increase health literacy and understanding of pain.
  5. Content Article
    Current modules available: Foundation Newly diagnosed Meet the team Managing pain and flares A module on Medicines and Treatment (to be launched)
  6. Content Article
    This GIRFT report for rheumatology makes 23 recommendations to improve care for patients including: redesigning services for patients with non-inflammatory painful musculoskeletal conditions. reducing hospital visits. improving access to care for rare conditions. You will need a FutureNHS account to view this report, or you can watch: a short video summary of the report which includes key recommendations. the recording of a webinar about the report held on 1 October 2021.
  7. Content Article
    A few weeks ago, a painful and rapidly-swelling elbow forced me to pick up the phone and ask for help. I have rheumatoid arthritis, treated by immunosuppressive biologic drugs and complicated by other health issues. In ‘normal times' I am supposed to see my consultant every six months. But due to Covid-19, I had not seen her in two years and was muddling along by myself. So I wrote myself a script, made sure I had all the information I needed and psyched myself up to fight for an appointment with whoever I reached after navigating the hospital switchboard. Amazingly, I got through to my rheumatologist’s secretary at the first attempt. I explained my situation and, if I’m honest, was shocked by the compassion and understanding she showed me. “That sounds really difficult, I’ll get you an appointment as soon as I can.” She found me a phone appointment in six weeks time, apologised for the wait and the fact that it wasn't in person, and gave me the number of the rheumatology nurse helpline in case they could offer me anything else in the meantime. I couldn’t have felt better served or more cared for. It left me wondering why I hadn’t called before. And then I remembered the reasons - and realised this pleasant interaction felt like an anomaly. Why patients don’t ask for help There are so many reasons that stop patients proactively seeking the care they know they need, including: lack of clarity about who to contact or difficulty getting through. difficult past interactions that left you feeling dismissed and belittled. lack of follow-up when you have been in touch before. believing there are others worse off, that your needs aren’t important enough. previous harm or treatment mistakes. believing you will be ‘adding to the problem’ of the Covid-19 elective care backlog. Most patients, particularly those with a long-term condition, will identify with some of these reasons. But central to most of them is the idea of damaged trust, and it is many separate experiences that contribute to this erosion of patient confidence. Trust in the NHS, or any healthcare system, is a nuanced picture for each individual patient. But it warrants attention, as lack of trust has a huge impact on patients’ ability and willingness to access the healthcare system that, after all, exists to look after them. That in turn negatively affects their health outcomes and safety.[1] Two years into this pandemic, trust is more important now that it has ever been, but I fear that with every strained conversation and cancelled appointment, it is gradually ebbing away from patients. Patients and the NHS - it’s complicated In a healthcare setting, relationships are complex as they are not just about individuals, but a whole system. When I sit on the phone to a locum GP, both of us come to the consultation with loaded preconceptions - she of the thousands of patients she has seen, and I of the many doctors I have sat opposite before. The weight of the system sits heavy. The impact this has on experiences of care should not be underestimated. Increasing trust between patients and clinicians is key to patient safety, and for patients with long-term conditions, lack of trust can have a particularly profound effect. A good example of this is the UK Government’s vaccine rollout in Spring 2021. The universal public message was “Don’t contact us, we won’t forget you.” While I understand where this message came from - the need to protect immensely stretched NHS services - I wonder whether anyone in that comms meeting considered how that would be heard by some of the people it was aimed at. People who had been told they were ‘clinically extremely vulnerable’, who in some cases had spent months at home, alone. People for whom the vaccine meant freedom. People who are more likely than most to have experienced ‘being forgotten’ by the NHS before. In the end, anxiety about this led many, myself included, to call their GP to find out if they were ‘on the list’. In my case, I was accused of trying to ‘queue-jump’ while a friend at another GP surgery was told they were being ‘a nuisance’. My purpose in sharing this is not to have a go at individual staff, who were undoubtedly under huge pressure, but to highlight the impact that even brief interactions can have on a patient’s trust in their health services. I have certainly noticed that I am more reluctant to contact my GP since that incident. It was lack of trust that the system would look after me that made me call, and the call itself that further eroded my faith in the compassion and competence of the health system. Better communication builds trust People are often at their most vulnerable and anxious in healthcare settings, meaning that interactions have a particularly profound effect on how they view their treatment and the people involved. As a patient, here are four observations about how improving NHS communication could increase patient trust in the healthcare system. None of them are novel suggestions, but the need to prioritise them feels particularly important at the moment. Increase understanding of shared decision making Patients and clinicians alike need to really understand shared decision making and the role that patients have in ensuring their treatment is right for them. Shared decision making takes longer,[2] but it has proven benefits in reducing harm and improving outcomes.[3] We need better education for all parties about shared decision making if it is to become the norm for healthcare in the UK. It is encouraging to see organisations developing tools that can help patients prepare for consultations and understand which information will be useful to share, but we need to make sure all patients can access them. Address concerns and past harm A consultation needs to be about more than just the symptoms a patient is experiencing at that moment. Doctors who take time to understand where a patient’s hesitations come from are able to instil trust and help deal with those concerns. Allowing space for patients to talk about difficult healthcare experiences and feel heard can make a huge difference. This takes time, but those additional minutes are an investment in the patient’s health and future healthcare interactions. Trust works both ways, and as a patient I feel more relaxed and able to listen to a doctor’s expertise when they take my lived experience seriously. Identify and train the gatekeepers Clinicians understandably can’t be accessible to all patients at all times, so receptionists and other staff act as the gatekeepers to treatment. That’s why it is so important that these individuals communicate well with patients. A conversation that leaves a patient feeling unimportant and dismissed, even if it is polite, results in frustration and resentment, not just towards the gatekeeper but perhaps the whole department, hospital or NHS. Their role is vital in building patient trust and confidence, as my phone call with the rheumatology secretary demonstrates. Training and good systems that allow gatekeepers to offer the right information and support will help ensure patients don’t feel they are being denied access to the care they need. Maintain contact and foster transparency Many patients recognise the limitations placed on the NHS because of the ongoing impact of Covid-19; they just want to be kept in the loop. I have heard very little about my ongoing treatment from either hospital specialty I am under since January 2020. I have no idea whether anyone is looking at my regular blood test results or whether I’m even still ‘on the books’. I don’t know what I should do if I need support, and when I’m likely to be contacted next. Contact takes a bit of time, but it means patients don’t feel forgotten and gives them license to seek help when they really need it. Perhaps it’s time to invest in systems that make it easy to contact patients and bridge the gap between now sparse appointments. A question of resources Sadly, each of these solutions require something NHS services are very short of at the moment - time. NHS staff are under immense pressure every day, with record numbers leaving the NHS under the strain of Covid-related PTSD or simply having ‘had enough’. As staff become fewer, the pressure on remaining staff builds. Patients feel this strain and sense the pressure, and doubts about whether the system really has their back can grow. The issue of trust is a complex one with no easy fixes, but the more we can facilitate positive interactions and relationships, the more confidence all parties will have in our healthcare system. If trust can be built and maintained, patients like me will feel safer and more at ease when they need to access care. Of course, whether the government sees enough value in building trust in the NHS to properly invest in it, is another question altogether. References [1] F Chipidza, Rachel Wallwork and Theodore Stern. 'Impact of the doctor-patient relationship'. Prim Care Companion CNS Disord. 2015:17(5):10 [2] S Lenzen, R Daniëls, M Amantia van Bokhoven et al. 'What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation'. International Journal of Nursing Studies. 2018:80:1-11 [3] C Okoli, G Brough, B Allan et al. 'Shared decision making between patients and healthcare providers and its association with favorable health outcomes among people living with HIV'. AIDS and Behavior. 2021:25:1384–1395
  8. Content Article
    Key findings of the report include: 47% of Black, Asian and ethnic minority patients and 43% of white patients were referred to rheumatology services within three working days of presenting (Quality statement 1) 43% of Black, Asian and ethnic minority patients and 42% of white patients were assessed within three weeks of referral 2013 version of QS33 (Quality statement 2) A higher proportion of Black, Asian and ethnic minority patients (60%) received timely treatment compared to white patients (57%) (Quality statement 2) A high proportion of both groups of patients were provided with disease-related education (93% of Black, Asian and ethnic minority patients and 94% of white patients) (Quality statement 3) A high proportion of both groups of patients were able to access care in case of emergencies (91% of Black, Asian and ethnic minority patients and 93% of white patients) (Quality statement 4) 34% of Black, Asian and ethnic minority patients and 46% of white patients received a formal annual review (Quality statement 5).
  9. Content Article
    The report addresses MSK inequalities in the following categories: Digital access and health literacy Communities Prevention Children and young people Data Waiting lists Care gap Status of MSK
  10. Content Article
    The authors of the study conducted surveys and interviews with patients and clinicians between April and July 2021. The majority of patients were from the UK and had inflammatory arthritis or lupus. The study found the following: Patients and clinicians rated telemedicine as worse than face-to-face consultations in almost all categories, although >60% found it more convenient. 93% of clinicians and 86% of patients rated telemedicine as worse than face-to-face for assessment accuracy. Building trusting medical relationships was a great concern. Telemedicine was perceived to have increased misdiagnoses, inequalities and barriers to accessing care. Participants reported highly disparate telemedicine delivery and responsiveness from primary and secondary care. Although rheumatology clinicians highlighted the importance of a quick response to flaring patients, only 55% of patients were confident that their rheumatology department would respond within 48 hours. The study concludes that although some negative experiences may have been due to the pandemic rather than telemedicine itself, there is still a strong preference for face-to-face consultations in rheumatology. This is because of the high risk of greater diagnostic inaccuracies when using telephone consultations.
  11. News Article
    A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say. Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care. The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year. “We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.” Read full story Source: The Guardian, 20 November 2020
  12. Content Article
    The rheumatology community has created a global, coordinated and timely response to the COVID-19 pandemic. The alliance aims to harness the breadth of expertise and knowledge in the rheumatology physician and patient communities to advance knowledge about COVID-19 for the benefit of all patients with rheumatic diseases.
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