Chris Butler presentation WSPCR 2010


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Chris Butler presentation WSPCR 2010

  1. 1. Our vision for Teaching and Research Public Health and Primary  Care   Chris Butler  Head of Department of Primary Care and Public Health  Cardiff University  Director, Wales School of Primary Care Research 
  2. 2. This was my view from Llanedeyrn… 
  3. 3. Primary Care & Public Health Neuadd Meirionnydd  South East Wales Trials Unit  Wales Cancer Trials Unit   & Cancer RRG  ParIcipant Resource Centre  Epidemiology & Screening RRG  Central PCAPH admin  Postgraduate teaching  Undergraduate teaching  Wales School for Primary Care  Decision making laboratory  Clinical Epidemiology IRG  Postgraduate research 
  4. 4. Mission statement Our mission is to promote well‐being and dignity by reducing the  populaIon burden of disease and improving health care through  high quality research, teaching, clinical service and innovaIon and  engagement.  Our core aims are to:  •  Provide excellent educaIon and training for health care  professionals •  Use our mulIdisciplinary, integrated research environment to:  –  Promote healthier communiIes  –  Develop relaIonship based, holisIc, cost effecIve individual care  –  Contribute to the understanding and reducIon of health inequaliIes,  parIcularly in Wales 
  5. 5. Achievements.. •  180 people •  165 teaching pracIces •  Best rated teaching in the curriculum •  65% 3* and 4* in RAE 2008 (=second best health  submission form Wales) •  Research income since 2008 nearly £15M;  highest of all groups in School of Medicine •  Total Value since 2008 £26.5M •  >50 ongoing studies •  Involved in winning infrastructure grants >£30M 
  6. 6. Theme •  Understanding unhelpful/harmful variaIon in  the causes of ill health and health care  delivery  •  Developing and evaluaIng intervenIons  to  address this with people/paIents are the  centre •  Locally relevant, internaIonally applicable •  InternaIonally excellent 
  7. 7. Health stats… 
  8. 8.  ”A pathophysiology of disempowerment and degrada5on” 
  9. 9. Within the UK, over 95% of NHS clinical contacts are made in general pracIce and around 80% of health problems are managed at this level. Over 300 million general pracIce consultaIons take place in the UK each year; these encompass health promoIon, prevenIon and screening as well as acute and chronic care. 
  10. 10. Primary care  •  Helps prevent illness and death •  Associated with more equitable distribuIon of  of health in a populaIon 
  11. 11. Primary care: four pillars 1.  First contact for each new health need 2.  Long term (person‐(not disease) focused 3.  Comprehensive for most health care needs 4.  Coordinated care when it must ne sought  elsewhere 
  12. 12. The evidence… •  Heath is beier in areas with more primary  care physicians  •  All cause mortality less  •  Beier HRQL  •  Less low birth weight •  People who receive care from primary care  physicians are healthier •  The characterisIcs of primary are associated  with beier health 
  13. 13. Mechanisms •  Greater access to needed services •  Beier quality of care •  Greater focus on prevenIon •  Earlier management •  PrevenIon of unnecessary and potenIally  harmful specialist care 
  14. 14. Primary Care in 11 countries Primary Expenditure Health Medicines Average Care per head indicators prescribed rank for ranking per head outcomesUS 11 11 8 7 8.5UK 1 2 9.5 4 5.4 • Starfield B, Lancet 1994;3441129-1133 • 1 is best, 11 worst
  15. 15. IdenIfying unhelpful variaIon  Sectional page 95 Proceedings of the Royal Society of Medicine Soit1219 Vol. XXXI $ectioII of Eptibemii0o[ogp anb !tate IDebicinie President-Sir ARTHUR MACNALTY, K.C.B., M.D. [May 27, 1938] The Incidence of Tonsillectomy in School Children J. ALISON GLOVER, O.B.E., M.D., F.R.C.P., D.P.H. THE rise in the incidence of tonsillectomy is one of the major phenomena of modern surgery, for it has been estimated that 200,000 of these operations are performed annually in this country and that tonsillectomies form one-third of the number of operations performed under general ancesthesia in the United States. There are, moreover, features in the age, geographical and social distribution of the incidence, so unusual as to justify the decision of the Section of Epidemiology to devote an evening to its discussion. HISTORY It seems unnecessary to review the history of operative treatment of the tonsil, and I will confine myself to pointing out that while it was natural that, in pre- anaesthetic and pre-Listerian days, the incidence of operation should be very small, it is astonishing to find how recent is the great vogue of the operation. For many years after the introduction of aneesthesia and aseptic surgery the incidence remained low. In 1885 that great physician Goodhart [14] said, " It is comparatively seldom that an operation is necessary, and fortunately so, for parents manifest great repug- nance to it. Children grow out of it, and at 14 or 15 years of age the condition ceases to be a disease of any importance ". These words were repeated in several subsequent editions. In 1888 I went to a preparatory boarding school of 50 boys, and then, in 1890, to a public school of 650 boys. Though, as the son of a doctor and destined for the profession myself, I took some interest in medical matters even then, I cannot recall a single boy in either school who had undergone the operation. Both schools still flourish, but the percentage of tonsillectomized boys is now in both alike about 50%, and, as we shall see later, even this is nowadays a low figure for schools of these types. Old photographs reveal little difference in appearance between the untonsillec- tomized fathers and the tonsillectomized sons, and although the latter seem to grow taller and heavier than we did, memory suggests that we were at least as resistant to infection. EARLY ESTIMATES OF THE NEED FOR OPERATION It is difficult to estimate the number of operations previous to the introduction of the School Medical Service. Any such estimate is derived either from estimates of the number of children whose tonsils are said to " require immediate operations" or from hospital records. In 1903 the Report of the Royal Commission on Physical Training (Scotland) gave the age-and-sex grouped results of the examination of 600 Edinburgh and 600 Aberdeen school children, in tables, which showed well the two periods of physiological AU G.-EPID. 1
  16. 16. Wales today 
  17. 17. MATCH Leaflet 
  18. 18. Shared decision‐making: a meeIng  between experts  Joint prescribing decision•  InformaIon exchange is two‐way •  Clinician provides relevant informaIon about  treatment opIons •  PaIent provides informaIon about their lived  experience of the illness, their values, preferences,  lifestyle and knowledge about the treatment  Butler C et al. JAC 2001; 48:435–440
  19. 19. University Research InsItute 
  20. 20.   Family Nurse Partnership Programme   •  A structured, intensive home  visiIng programme delivered by  Family Nurses to pregnant  teenagers •  Programme runs through  pregnancy and unIl baby’s second  birthday. •  Licensed programme developed  and tested in the USA with fidelity  measures to ensure replicaIon of  original research  
  21. 21. Visi5ng Schedule •  1/week first month •  Every other week during  pregnancy •  1/week first 6 weeks aner  delivery  •  Every other week unIl 21  months •  Once a month unIl age 2 
  22. 22. Overview of the Trial  Study Outcomes Outcome domain  Primary  Secondary Pregnancy & birth  • Changes in prenatal tobacco use  • IntenIon to breaspeed  (maternal measure)  • Prenatal aiachment  • Birth weight (child measure) Child health &  • Emergency aiendances /  • Injuries & ingesIons development  admissions within two years  • Breast feeding (iniIaIon  of birth  & duraIon)  • Language development Maternal life course  • ProporIon of women with a  • EducaIon and economic self‐ second pregnancy within two  • Employment sufficiency  years of first birth  • Health status  • Social support  Paternal involvement 
  23. 23. ImplemenIng an integrated vision… 
  24. 24. Previous Academic Fellows  On compleIon  Continued as GP in Further Academic Academic Fellow Dates Publication? Teaching? Post Grad. Qualification Valleys? Post?Anne-Marie Cunningham 2001-03 MSc Pub HealthLiz Metcalf 2001-03 MSc Med EdDiane Owen 2002-04 MSc Pub HealthJosep Vidal-Alabal 2002-04 MSc Pub HealthJo Davies 2002-05 Cert Med EdKathy O’Brien 2003-05 Cert Med EdNick Francis 2003-05 Fellowship App: PG Dip EpidemiologySandra Jones 2004-06 Cert Med EdYolande Robles 2004-06 MSc Pub HealthChantal Thomas 2005-07 Dip Med EdJane Fryer 2005-07 MSc Med EdDella Williams 2005-06 Cert Med EdNaomi Cadbury 2005-07 Cert Med EdRachel Andrew 2006 Cert Med EdLisa Williams 2006-07 Cert Med EdBrechje Brocken 2007-08 Cert Med EdJim Pink 2006-08 Cert Med EdNaomi Stanton 2007-08 Dip Pub HealthLucy Morris 2007-09 Cert Med Ed DFSRHEmma Melbourne 2007-09 Cert Med EdNathan Francis 2008-2010 MSc Public Health -progressing 2008-Bethan Stephens Cert Med Ed 2010
  25. 25. Glyncorrwg 
  26. 26. From this… 
  27. 27. To this.. 
  28. 28. Same old same old (but with  a beier  view)? •  Not a: silo, outpaIent‐verIcal, QoF driven  model •  ConInuous, longitudinal integrated care, teaching and  research for whole populaIon •  Truly mulIdisciplinary: nursing, admin, palliaIve care,  learning disabiliIes, psychiatry, child health, obstetrics,  minor injuries •  Integrated with voluntary sector, social services, social care  and local authority, planning •  Begin with paIents problems •   Put on  strei‐strip, catheterize, make diagnoses •  24 hour care •  Community led/buy in 
  29. 29. Stoi and Davies revisited 
  30. 30. E  F  Who can I teach?  What can I learn?    What data can be  contributed?    
  31. 31. Three stage (triple diagnosis) model •  Biomedical •  Psychological  •  Social 
  32. 32. Five stage model •  Biomedical  •  Biomedical •  Psychological   •  Psychological •  Social  •  Social  •  Environmental  •  Spiritual 
  33. 33. Diolch yn fawr