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Content ArticleDespite their widespread use, the impact of commissioners’ policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. This study in BMC Medicine aimed to assess the impact of policies for BMI on access to hip replacement surgery in England. The authors used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. They found that rates of surgery fell after localities introduced policies restricting access to surgery based on BMI, whereas rates rose in localities with no policy. Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities, and policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. The authors recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.
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Content ArticleThis blog by the British Society for Rheumatology (BSR) shares highlights of the evidence given to a House of Lord's inquiry into homecare medicines services' governance and accountability. The witness sessions heard evidence on levers for accountability, performance and safety, e-prescribing and workforce. The blog looks at challenges faced by providers, the need for improved regulation and accountability and lack of data and KPIs. It also describes a desktop investigation being undertaken by NHS England to understand the range of arrangements that are in place and how homecare medicines services are held to account.
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Content ArticleDuring the pandemic, approximately 4.1 million people across the UK were identified as clinically extremely vulnerable (CEV) to Covid-19, and asked to shield for their own protection. This decision, made in the light of an unprecedented pandemic, would separate those with autoimmune inflammatory conditions, such as rheumatoid arthritis, from the rest of society for their own protection. This report by the charity Versus Arthritis presents qualitative research led by Dr Charlotte Sharp, a consultant rheumatologist, Lynn Laidlaw who has an autoimmune rheumatic disease and had to shield, and patient contributor Joyce Fox from the Centre for Epidemiology at the University of Manchester. It highlights the stories of people who lived through shielding and details the impact on their daily lives, their physical and mental wellbeing, their work, and their relationships with their families and the rest of society.
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News Article
Hundreds of rheumatology patients wrongly prescribed drugs or misdiagnosed
Patient Safety Learning posted a news article in News
Hundreds of rheumatology patients have stopped receiving drugs they did not need or had their diagnosis changed after a damning review of the service found the standard of care was “well below” what would be considered acceptable. Jersey’s Health and Community services department has said it will be contacting some of the affected patients “over the coming weeks” and would also be seeking legal advice on “an appropriate approach to compensation”. The independent review by the Royal College of Physicians also noted there was “no evidence” of standard operating procedures for most aspects of routine rheumatological care and, in some cases, “no evidence of clinical examinations”. It also found that there had been incorrect diagnosis and wrongly prescribed drugs, describing the standard of care as “well below what the review team would consider acceptable” for a contemporary rheumatological service. The review was commissioned by HCS medical director Patrick Armstrong, following concerns raised by a junior doctor in January 2022. Read full story Source: Jersey Evening Post, 22 January 2024 -
News Article
Patients’ experiences of disease should be taken more seriously, says study
Patient Safety Learning posted a news article in News
Health experts say more attention should be given to patients’ experiences after research found multiple examples of their insights being undervalued. A study led by the University of Cambridge and King’s College London found clinicians ranked patient self-assessments as the least important when making diagnostic decisions. Ethnicity and gender were felt to influence diagnosis, particularly a perception that women were more likely to be told their symptoms were psychosomatic. Male clinicians were more likely to say that patients overplay symptoms. The findings prompted calls for clinicians to move away from the “doctor knows best attitude” when caring for patients. One patient shared the feeling of being disbelieved as “degrading and dehumanising”, and added: “I’ll tell them my symptoms and they’ll tell me that symptom is wrong, or I can’t feel pain there, or in that way.” Read full story Source: The Guardian, 18 December 2023 -
News Article
Rheumatoid arthritis drug appears to help Covid patients in ICU
Patient Safety Learning posted a news article in News
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 -
Content ArticleGetting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. 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.
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Content ArticleAnnette McKinnon is a patient with chronic disease. Her experience has led her to be involved in trying to change healthcare so that the voice of the patient is included in decisions. She is a volunteer member of many groups and committees and is a patient partner on several Canadian research teams. In her blog, published by the BMJ, Annette discusses the importance of patient-centred care, information sharing and the barriers to achieving this.
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Content ArticleThe global COVID-19 pandemic has the potential to severely affect those with rheumatic diseases or who are taking immunosuppressive therapies. Information is lacking as to how these groups will fare if they become infected. A global alliance has rapidly formed to try to address this information deficit. 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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Content ArticleIncreasing numbers of people are living with long-term conditions. By 2035, projections suggest that two-thirds (68%) of adults in England aged 65 or above will have two or more conditions; many (17%) will have four or more. At a time when the NHS' primary care workforce is facing unprecedented demands, stratified care for people with long-term conditions could optimise use of NHS resources and improve outcomes. Stratified care has the potential to personalise treatment, improve health outcomes and save NHS resources. In a stratified approach, the different needs of patients (grouped according to their age, ethnicity, BMI or other characteristics) influence the choice of care pathway. In this collection, the National Institute for Health Care and Research (NIHR) present examples of NIHR research on stratified approaches to four common long-term conditions: diabetes chronic obstructive pulmonary disease depression musculoskeletal conditions. This Collection will be useful to primary care clinicians and commissioners.
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Content ArticleAiring Pain is a podcast from Pain Concern. Each edition brings together people in pain and top specialists to talk about resources that can help. This edition investigates the significant inequalities and disparities in treatment among primary care pain management services. It features the following participants: Professor Jonathan Hill, Director of Research for the School of Allied Health Professionals and Professor of Physiotherapy at the Keele School of Medicine; Dr Ama Kissie, post-doctoral fellow at the University of Ghent and a Clinical Psychologist; Dr Whitney Scott, clinical psychologist who lectures at Kings College London and is the research lead at the INPUT Pain Management Unit at Guy’s & St Thomas’ Hospital.
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Content ArticlePeople taking methotrexate (for inflammatory conditions such as rheumatoid arthritis) have regular blood tests to check for certain side effects. Researchers have developed a tool to predict the likelihood of them discontinuing methotrexate due to these side effects, which could in future lead to less frequent testing for most people (68%) on methotrexate. The tool uses information routinely collected by GPs. The study found that it could predict people’s risk of discontinuing methotrexate because of side effects. It was accurate for most people across different ages, inflammatory conditions, methotrexate doses and routes of administration. The researchers say the tool could in future be used by GPs to identify people who need more or less frequent blood tests. This article refers to the original research study Risk stratified monitoring for methotrexate toxicity in immune mediated inflammatory diseases: prognostic model development and validation using primary care data from the UK
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Benjamin talks about why we need a radical shift in how we view and treat people with chronic pain and how over-investigation and over-treatment compromise patient safety. He also talks about the power of communal singing for people with long-term conditions and what wild swimming has taught him about supporting people living with chronic pain.- Posted
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Content ArticleIn a study published in Rheumatology, researchers used the example of neuropsychiatric lupus, an incurable autoimmune disease that is particularly challenging to diagnose, to examine the different value given by clinicians to 13 different types of evidence used in diagnoses. This included evidence such as brain scans, patient views, and the observations of family and friends. The research, led by a team at the University of Cambridge and Kings’ College London, found that clinicians ranked patient self-assessments as least important in diagnostic decisions, and said that patients both over- and under-played their symptoms more often than patients reported doing so. One patient shared the common feeling of being disbelieved as “degrading and dehumanising” and added: “If I had continued to have regard for clinicians’ expertise over mine, I would be dead… When I enter a medical appointment and my body is being treated as if I don’t have any authority over it and what I’m feeling isn’t valid then that is a very unsafe environment… I’ll tell them my symptoms and they’ll tell me that symptom is wrong, or I can’t feel pain there, or in that way.” Fewer than 4% of clinicians ranked patient’s self-assessments in the top three types of evidence. Clinicians ranked their own assessments highest, despite acknowledging that they often were not confident in diagnoses involving often invisible symptoms, such as headache, hallucinations, and depression. Such ‘neuropsychiatric’ symptoms can lead to low quality of life and earlier death and were reported to be more often misdiagnosed – and therefore not correctly treated – than visible ones such as rashes. Lead author, Dr Melanie Sloan from the Department of Public Health and Primary Care at the University of Cambridge, said: “It’s incredibly important that we listen to and value patients’ insights and their own interpretations of their symptoms, particularly those with long-standing diseases – after all, they are the people that know what it is like to live with their condition. But we also need to make sure that clinicians have the time to fully explore each patient’s symptoms, something that is challenging within the constraints of current health systems.”
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Content ArticleSerious pathology as a cause of musculoskeletal (MSK) conditions is considered rare, but it needs to be managed either as an emergency or as urgent onward referral as directed by local pathways. This guidance supports primary and community care practitioners in recognising serious pathology which requires emergency or urgent referral to secondary care in a patient who present with new or worsening MSK symptoms.
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Content Article
NRAS - SMILE-RA e-learning for patients
Patient-Safety-Learning posted an article in Patient engagement
SMILE (Self-Management Individualised Learning Environment) is an e-learning experience for people with rheumatoid arthritis (RA) who want to learn more about RA, its treatments and how to become good at self-managing. Each module is on a particular theme or subject and takes between 20 mins and half an hour to complete. Current modules available: Foundation Newly diagnosed Meet the team Managing pain and flares A module on Medicines and Treatment (to be launched) -
Content ArticleDisease-modifying antirheumatic drugs (DMARDs) are a group of medications commonly used in people with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus (SLE). They work by work suppressing the body's overactive immune and/or inflammatory systems and take effect over weeks or months. This information guide gives information for patients on conventional and biologic DMARDS, including how they work, the different kinds available and their side effects.
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Content ArticleA broken hip or ‘hip fracture’ is a serious injury, which each year in the UK leads to around 75,000 people needing hospital admission, surgery and anaesthesia, followed by weeks of rehabilitation in hospital and the community. The National Hip Fracture Database (NHFD) is an online platform that uses real-time data to drive Quality Improvement (QI) across all 163 hospitals that look after patients with hip fractures in England and Wales. This report highlights key research carried out using data from the NHFD in 2021, and makes a number of recommendations to improve treatment and outcomes for patients with hip fractures. 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.
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Content ArticleIn England, around 10 million adults and 12,000 children have a musculoskeletal (MSK) condition. Ethnic minority groups, people from lower income households and those living in areas of high deprivation are most affected. In this guest blog for the Arthritis and Musculoskeletal Alliance (ARMA), Bola Owolabi, Director of the National Healthcare Inequalities Improvement Programme at NHS England, highlights the role that MSK health inequalities play in people's lives. She looks at the link between socio-economic disadvantage and poor health outcomes, and discusses the wider implications of disability due to MSK conditions. She describes work being done by the NHS, and highlights ARMA's work to narrow MSK health inequalities through listening to the experiences of underserved communities and working in partnership to improve care.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Tony talks to us about making patient safety everyone’s responsibility, the importance of open communication and how his understanding of different global health systems has broadened his perspective on what matters in patient care. -
News Article
Rheumatic patients 'left behind' after lockdown
Patient Safety Learning posted a news article in News
Patients with rheumatic conditions who shielded during the pandemic feel "left behind", according to new research. The University of the West of England (UWE) in Bristol conducted a study with patients about their experiences of shielding during the pandemic and how it continued to affect them. Researchers interviewed 15 rheumatology patients from the Bristol area. Pamela Richards, who suffers with arthritis, said the pandemic has been "a massive blow" to the way she lives. "I have never experienced anything like shielding, it heightened a sense of anxiety in me," said Ms Richards. "How do I get food? I cannot leave the house. How can I see friends? I was not allowed to." Ms Richards, who shielded for nearly two years during the pandemic, said that life has not returned to normal, despite no longer being advised to shield. "It is a new normal, which is about being on high alert and managing risk every day," she said. Researcher Christine Silverthorne said: "Many are still dealing with lasting physical and mental effects both from the experience of shielding and as a consequence of delays to their healthcare and treatment". Read full story Source: BBC News, 6 March 2023 -
News Article
NHS in England will have one strategy for all major conditions, including cancer
Patient Safety Learning posted a news article in News
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 -
Content ArticleDecision support tools, also called patient decision aids, support shared decision making by making treatment, care and support options explicit. They provide evidence-based information about the associated benefits/harms and help patients to consider what matters most to them in relation to the possible outcomes, including doing nothing. NHS England has just published a suite of eight decision support tools that will help people with their healthcare professionals in clinical consultations, about their treatment choices for their condition through shared decision making. NHS England has worked with patients, patient charities health professionals and research teams over several months to develop the tools in line with NICE guidance on shared decision making standards. 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
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Content ArticleIn the 2017 Health Survey for England, 34% of adults reported experiencing chronic pain. The survey found that 5.5 million people (12%) are affected by high-impact pain that prevents them from enjoying social, family and recreational activities, and from working, including carrying out household tasks. This document sets out what the Arthritis and Musculoskeletal Alliance (ARMA) believes should be available in every area for people living with long term pain. It covers four areas: Underpinning framework Treatment for underlying conditions Services for people living with chronic pain Prevention and inequalities
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Content ArticleChronic (persistent or long-lasting or recurrent) pain is life-changing and can significantly impact individuals, their families and carers. This paper sets out the Arthritis and Musculoskeletal Alliance's (ARMA's) position on how pain affects people with musculoskeletal conditions, and how their pain should be managed. 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.
