Improving identification and brief advice for alcohol in hospital patients: a new sustainable model using medicine management technicians.

Alcohol identification and brief advice (IBA) is effective for reducing increased risk alcohol consumption, but systematic sustainable screening systems in hospitals are often lacking. University Hospital Southampton NHS Foundation Trust implemented a trust-wide IBA system by integrating it into a patient's medicines reconciliation review undertaken by medicines management technicians (MMTs) on admission. After an initial pilot, this model was rolled out across the trust and has resulted in a substantial increase in the number of patients screened and accurately coded for alcohol use. Surveys of MMTs have shown their confidence and competence in asking patients about their alcohol has increased since implementation.

Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial.

OBJECTIVE: To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC). DESIGN: This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015. SETTING: 151 general practices in Hampshire, England, UK. PARTICIPANTS: 366 005 participants born 1 April 1940-31 March 1976 eligible for an NHS HC. INTERVENTION: NHS HC invitation. MAIN OUTCOME MEASURES: HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10% and >20%, smokers, and total cholesterol (TC) >5.5 mmol/L and >7.5 mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT). RESULTS: HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%-3.6, p<0.001) and >20% (0.1%-0.6%, p<0.001-0.392), TC >5.5 mmol/L (4.1%-7.0%, p<0.001) and >7.5 mmol/L (0.3%-0.4% p<0.001), hypertension (0.3%-0.6%, p<0.001-0.003), and interventions with statins (0.2%-0.9%, p<0.001-0.017) and antihypertensives (0.1%-0.6%, p<0.001-0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95% CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5 mmol/L (3.72, 3.57 to 3.89) and >7.5 mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10% plus statin and >20% plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation. CONCLUSIONS: HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.

Determining doctors' views on performance measurement and management of their clinical practice.

Introducing performance measurement and management of clinicians' practice may improve clinical productivity and quality of patient care; however the attitudes of doctors to such approaches are poorly defined. This was investigated through an anonymous qualitative postal questionnaire in a large district general hospital. A total of 93 from an invited cohort of 368 senior grade doctors participated. The results suggested that doctors understood the need to evaluate and manage their performance in medical practice, and address poor performance, but felt that current methods were inadequate. This principally related to poor validation and a lack of clinical ownership of data. The role of financial incentivisation was unclear but value was attributed to local clinical leadership, professional autonomy, recognition, and peer-group comparisons. This suggests that clinicians support the use of data-based performance measurement and management; however how it is undertaken is key to successful clinical engagement.