Developing resources to support the diagnosis and management of Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) in primary care: a qualitative study.

BACKGROUND: NICE guidelines emphasise the need for a confident, early diagnosis of Chronic Fatigue Syndrome/ Myalgic Encephalitis (CFS/ME) in Primary Care with management tailored to the needs of the patient. Research suggests that GPs are reluctant to make the diagnosis and resources for management are currently inadequate. This study aimed to develop resources for practitioners and patients to support the diagnosis and management of CFS/ME in primary care. METHODS: Semi structured interviews were conducted with patients, carers, GPs, practice nurses and CFS/ME specialists in North West England. All interviews were audio recorded, transcribed and analysed qualitatively using open explorative thematic coding. Two patient involvement groups were consulted at each stage of the development of resources to ensure that the resources reflect everyday issues faced by people living with CFS/ME. RESULTS: Patients and carers stressed the importance of recognising CFS/ME as a legitimate condition, and the need to be believed by health care professionals. GPs and practice nurses stated that they do not always have the knowledge or skills to diagnose and manage the condition. They expressed a preference for an online training package. For patients, information on getting the most out of a consultation and the role of carers was thought to be important. Patients did not want to be overloaded with information at diagnosis, and suggested information should be given in steps. A DVD was suggested, to enable information sharing with carers and family, and also for those whose symptoms act as a barrier to reading. CONCLUSION: Rather than use a top-down approach to the development of training for health care practitioners and information for patients and carers, we have used data from key stakeholders to develop a patient DVD, patient leaflets to guide symptom management and a modular e-learning resource which should equip GPs to diagnose and manage CFS/ME effectively, meet NICE guidelines and give patients acceptable, evidence-based information.

Collaborative to decrease ambulance diversion: the California Emergency Department Diversion Project.

BACKGROUND: Ambulance diversion is a national problem that affects more than half of all emergency departments (EDs). Although diversion was meant to be used for short periods of time to offer temporary relief to EDs, it has evolved into a normal routine in many communities to manage the growing problem of ED and hospital crowding. STUDY OBJECTIVES: To assess the impact of a collaborative effort to decrease ambulance diversion. METHODS: This is a pre/post study investigating ED diversion in four emergency medical services agency regions in California from September 2006 through August 2008. Hospitals developed and implemented a number of best practices revolved around patient flow initiatives, specifically looking to improve input, throughput, and output. Monthly ED diversion data are compared and reported as means and standard deviations (SD). RESULTS: During the study period, there were a total of 31,735 diversion hours in the collaborative regions, with 17,618 during the pre-consortium period and 14,117 in the post-consortium period (19.9% decrease). The monthly average hours of diversion before the consortium was 1468 (SD = 390.6). This decreased to 1176 (SD = 605.8) after the initiation of the consortium (difference of 292 h; 95% confidence interval 99-484; p = 0.007). There was a decrease in diversion hours for every month-to-month comparison except January and February (increases of 1% and 14.6%, respectively). CONCLUSION: This study suggests that a decrease in ambulance diversion can be achieved through ongoing collaboration and the implementation of best practices. Continued communication and emphasis on diversion are likely needed to sustain these decreases.