Maximizing the role of emergency departments in the prevention of violence: developing an approach in South London.

This article presents an overview of a partnership between public health teams in two primary care trusts in South East London, their local acute hospital trusts, and crime and disorder reduction partnerships to support the reduction of harm from violence. It discusses recent developments in violence prevention in emergency departments in the UK, and developments around outreach and case management, more common in the USA. It then outlines the elements of the violence prevention project being conducted in South East London.

Achievement of metabolic targets for diabetes by English primary care practices under a new system of incentives.

OBJECTIVE: To analyse achievement of metabolic targets by English general practices following the introduction of a new system of incentives. METHODS: Clinical data were abstracted from the records of 2099 patients at 26 general practices in South London. Cross-sectional data for 2005 were obtained for all general practices in England, including characteristics of registered populations, practice organizational characteristics and 'Quality and Outcomes Framework' (QOF) metabolic targets. RESULTS: Among 26 practices in South London, the median practice-specific proportion of patients achieving HbA(1c) < or = 7.4% each year increased: 2000, 22%; 2001, 32%; 2002, 37%; 2003, 38% and in 2005 from QOF, 57%. In 8484 general practices in England in 2005, the median proportion of diabetic patients with HbA(1c) < or = 7.4% was 59.0%; the highest and lowest centiles ranged from 27.7 to 89.8% among general practices, from 46.9 to 71.0% among 303 primary care trusts and from 49.9 to 67.1.% among 28 health authorities. Comparing the highest and lowest tertiles of deprivation, the per cent achieving HbA(1c) < or = 7.4% was 2.96% (95% confidence interval 2.23-3.69%) lower in the most deprived areas. In areas with the highest proportion of ethnic minorities, the per cent achieving HbA(1c) < or = 7.4% was 2.73% (1.85-3.61%) lower than where there were few ethnic minorities. Practices with the highest total QOF organization scores had more patients achieving the HbA(1c) target (difference 5.03%, 4.43-5.64%). CONCLUSIONS: Intermediate outcomes are improving but deprived areas with less organized services achieve worse glycaemic control. Financial incentives may contribute to improved services and better clinical outcomes.