This document provides an overview of access to complementary and alternative medicine (CAM) in the NHS Scotland chronic pain service. It notes that nearly 40% of GP partnerships in England provide CAM access to NHS patients, and that chronic musculoskeletal pain is the most common reason people use CAM. Several government reports and clinical guidelines since 1994 have recommended CAM therapies like manual therapy and acupuncture for chronic pain conditions. However, access to CAM through the NHS is currently unequal, as it depends on how affluent patients are. The document proposes developing a referral pathway for GPs to refer patients to nationally-regulated CAM practitioners, and increasing dissemination of chronic pain resources, as ways to help address this inequality.
The document discusses improving quality and productivity in healthcare through initiatives like the Quality, Innovation, Productivity and Prevention (QIPP) program. It examines expanding prescribing and medicines supply roles for allied health professionals, including independent prescribing for physiotherapists and podiatrists, and supplementary prescribing for dietitians. The document also outlines existing mechanisms for patient specific directions, patient group directions, and exemptions that some health professionals can currently use for prescribing, supplying, and administering medicines.
Prescribing, administration and supply of medicines by allied health professi...MS Trust
This presentation by Helen Marriott, AHP Medicines Project Lead, looks at prescribing and medicines supply mechanisms and the AHP Medicines Project.
It was presented at the MS Trust Annual Conference in November 2014.
The Broad Picture - recent developments in long-term condition managmentepicyclops
This lecture was given by Dr Aileen Keel, Deputy Chief Medical Officer for Scotland, to the North British Pain Association Spring Scientific Meeting on Friday 18th May, 2007 and forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Reproduced with permission.
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
1) The study aims to validate an integrated telerehabilitation model to support post-acute coronary syndrome rehabilitation and secondary prevention using mobile technologies and telemonitoring.
2) Patients will be randomized into two groups - a control group receiving conventional in-hospital rehabilitation and an intervention group using a mobile app and telemonitoring for 10 months of at-home rehabilitation.
3) The primary outcome is adherence to exercise measured by questionnaires and exercise tests, with secondary outcomes of cardiovascular risk factor control, lifestyle changes, and cost analysis.
Acs0109 Fast Track Inpatient And Ambulatory Surgerymedbookonline
Fast track surgery aims to reduce complications, facilitate earlier discharge, and speed recovery after elective surgery. It involves a coordinated preoperative, intraoperative, and postoperative care plan using multiple evidence-based practices. The goal is that a multimodal approach will have synergistic benefits over using individual components alone. Key elements include preoperative education and optimization, attenuating the surgical stress response intraoperatively through techniques like neural blockade, and aggressive postoperative rehabilitation with early feeding and mobility. Successful implementation requires significant resources and coordination across specialties.
Making a difference - the benefits and challenges of non-medical prescribingMS Trust
This presentation by Nikki Embrey from the North Midland MS Service looks at the benefits of and barriers to nurse prescribing, and whether it can make a difference to patient outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
This document describes a quality improvement project to reduce readmissions among uninsured cardiac patients at a large public hospital on the U.S.-Mexico border. The project implemented a protocol to provide uninsured patients with a 30-day supply of essential medications upon discharge. Retrospective data showed high readmission rates and costs prior to the protocol. After implementing the protocol, zero readmissions occurred during the study period. The protocol demonstrated the value of ensuring uninsured patients can access needed medications to improve outcomes and reduce costly readmissions.
This document provides information about a non-medical prescribing course, including which allied health professionals are eligible and its structure. The course aims to qualify nurses, midwives, physiotherapists, podiatrists, chiropodists and radiographers as independent and/or supplementary prescribers. It is delivered over 26 days of taught content and 12 days of practice learning. Assessment includes a exam and portfolio demonstrating competence in prescribing practices. The document also discusses updates to prescribing competency frameworks and proposals to expand prescribing rights to radiographers and paramedics.
The document discusses improving quality and productivity in healthcare through initiatives like the Quality, Innovation, Productivity and Prevention (QIPP) program. It examines expanding prescribing and medicines supply roles for allied health professionals, including independent prescribing for physiotherapists and podiatrists, and supplementary prescribing for dietitians. The document also outlines existing mechanisms for patient specific directions, patient group directions, and exemptions that some health professionals can currently use for prescribing, supplying, and administering medicines.
Prescribing, administration and supply of medicines by allied health professi...MS Trust
This presentation by Helen Marriott, AHP Medicines Project Lead, looks at prescribing and medicines supply mechanisms and the AHP Medicines Project.
It was presented at the MS Trust Annual Conference in November 2014.
The Broad Picture - recent developments in long-term condition managmentepicyclops
This lecture was given by Dr Aileen Keel, Deputy Chief Medical Officer for Scotland, to the North British Pain Association Spring Scientific Meeting on Friday 18th May, 2007 and forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Reproduced with permission.
Integrative Telerehabilitation Strategy after Acute Coronary SyndromeIgnacio Basagoiti
1) The study aims to validate an integrated telerehabilitation model to support post-acute coronary syndrome rehabilitation and secondary prevention using mobile technologies and telemonitoring.
2) Patients will be randomized into two groups - a control group receiving conventional in-hospital rehabilitation and an intervention group using a mobile app and telemonitoring for 10 months of at-home rehabilitation.
3) The primary outcome is adherence to exercise measured by questionnaires and exercise tests, with secondary outcomes of cardiovascular risk factor control, lifestyle changes, and cost analysis.
Acs0109 Fast Track Inpatient And Ambulatory Surgerymedbookonline
Fast track surgery aims to reduce complications, facilitate earlier discharge, and speed recovery after elective surgery. It involves a coordinated preoperative, intraoperative, and postoperative care plan using multiple evidence-based practices. The goal is that a multimodal approach will have synergistic benefits over using individual components alone. Key elements include preoperative education and optimization, attenuating the surgical stress response intraoperatively through techniques like neural blockade, and aggressive postoperative rehabilitation with early feeding and mobility. Successful implementation requires significant resources and coordination across specialties.
Making a difference - the benefits and challenges of non-medical prescribingMS Trust
This presentation by Nikki Embrey from the North Midland MS Service looks at the benefits of and barriers to nurse prescribing, and whether it can make a difference to patient outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
This document describes a quality improvement project to reduce readmissions among uninsured cardiac patients at a large public hospital on the U.S.-Mexico border. The project implemented a protocol to provide uninsured patients with a 30-day supply of essential medications upon discharge. Retrospective data showed high readmission rates and costs prior to the protocol. After implementing the protocol, zero readmissions occurred during the study period. The protocol demonstrated the value of ensuring uninsured patients can access needed medications to improve outcomes and reduce costly readmissions.
This document provides information about a non-medical prescribing course, including which allied health professionals are eligible and its structure. The course aims to qualify nurses, midwives, physiotherapists, podiatrists, chiropodists and radiographers as independent and/or supplementary prescribers. It is delivered over 26 days of taught content and 12 days of practice learning. Assessment includes a exam and portfolio demonstrating competence in prescribing practices. The document also discusses updates to prescribing competency frameworks and proposals to expand prescribing rights to radiographers and paramedics.
This document discusses pharmacoeconomics, drug compliance, and therapeutic failure. It begins by defining pharmacoeconomics as the analysis of costs and consequences of pharmaceutical products and services. It then discusses various pharmacoeconomic methods like cost-benefit analysis and cost-effectiveness analysis. The document also explains drug compliance, adherence, and the consequences of non-compliance. It notes that non-compliance can result in therapeutic drug failure and increased costs. It concludes by discussing common interventions to improve compliance like patient education and simplifying drug regimens.
This document summarizes a patient satisfaction survey conducted at the Massachusetts General Hospital Cancer Center. It provides background on the importance of measuring patient satisfaction and assessing the interpersonal aspects of care delivery. The literature review discusses factors that influence patient satisfaction, such as health status, age, sex, and specific care experiences. It also describes common treatments for breast cancer and the challenges patients face. The document outlines the study's method, results, and discussion sections to evaluate patient satisfaction at the MGH Cancer Center clinic.
Muir Gray at the First National Conference on Health Care Quality RegistersTHL
The document discusses increasing value in healthcare systems through a "Triple Value Healthcare" approach. It proposes focusing on personal value for individuals, population value for given populations, and technical value through optimizing outcomes and resource use. Key strategies include providing full information to patients, shifting resources from overused to underused areas, developing population-based systems and networks, and creating a culture of stewardship. The goal is to improve outcomes while making the best use of limited resources.
This document describes a study that evaluated a new framework for end-of-life care and withdrawal of treatment on an intensive care unit. Staff completed questionnaires before and after the introduction of the framework to assess changes in knowledge, quality of care, and satisfaction. Results showed improvements in staff knowledge, increased confidence that patients' comfort needs were being met, and greater satisfaction with end-of-life care processes after implementing the framework. The study concludes the framework was associated with enhanced end-of-life care delivery and communication on the ICU.
This summarizes the outcomes of a 6-month pharmacist-provided diabetes management program for employees of the City of Toledo. The program showed improvements in clinical outcomes like A1c and blood pressure. It also improved humanistic outcomes such as patient satisfaction, knowledge, and adherence. Economic outcomes like healthcare utilization and costs improved as well, with a 62.69% reduction in total costs. The study demonstrates positive short-term outcomes across clinical, humanistic and economic domains from a pharmacist-led diabetes management program.
Making a difference: the benefits and challenges of non-medical prescribingMS Trust
This presentation by Dr Nicola Carey looks at the context of non-medical prescribing in the UK as well as its benefits and challenges.
It was presented at the MS Trust Annual Conference in November 2014.
This document summarizes key points from an IOM report on emergency care for children and discusses recommendations to improve pediatric emergency care readiness. It notes that children have unique medical needs that often aren't met in the emergency system. The three main goals discussed are coordination, regionalization, and accountability. Several recommendations are provided, including developing pediatric emergency care guidelines and competencies, appointing pediatric coordinators, improving safety, and enhancing family-centered and disaster preparedness.
This document discusses pharmacoeconomics and its importance in balancing the interests of stakeholders in the healthcare industry. It begins by defining health economics and pharmacoeconomics, and explaining their relationship. It then discusses the shift in focus of healthcare consumers towards disease prevention. The document outlines various challenges faced by the healthcare industry and how pharmacoeconomic solutions can address the perspectives of patients, physicians, insurers, manufacturers, researchers and policymakers. It provides a case study on drug selection for osteoarthritis using pharmacoeconomic analysis. Finally, it discusses the global presence and potential for establishing pharmacoeconomics in India.
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
The Effect of Protocol of Nursing Intervention on Quality of Care in Minor In...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
This article summarizes the results of establishing care pathways and an expert patient program for chronic conditions like diabetes, heart failure, and COPD in Barcelona, Spain. Key results include:
- Increased detection and monitoring of the conditions through improved protocols between primary and specialized care.
- Reduced hospital admissions and length of stay for heart failure patients.
- Increased patient knowledge and self-care through the expert patient program, which may have contributed to reduced heart failure admissions.
- High satisfaction among patients in the expert patient program.
1. Hospital statistics provide key information for health care decision-makers by analyzing clinical and financial data from hospitals. They summarize metrics like patient volumes, diagnoses, procedures, and revenue.
2. Core hospital statistics include administrative data on available beds, patient occupancy rates, and surgical volumes. Morbidity and mortality statistics track leading causes of illness and death by sex.
3. Calculating indicators such as average length of stay, bed turnover rate, and occupancy percentage helps monitor service delivery, plan facilities, and evaluate policies. However, hospital data only reflects patients seeking care and may not represent overall disease burdens.
This document reviews strategies to improve surgical outcomes through multimodal perioperative care approaches. It finds that newer perioperative care approaches have reduced both morbidity and mortality in surgical patients. Specifically, it discusses how regional anesthesia, minimally invasive surgery, intraoperative normothermia, and accelerated rehabilitation programs can reduce stress responses and complications after surgery. The major challenge is developing standardized "fast track" surgical programs using multimodal interventions to achieve pain-free and risk-free perioperative courses.
Non medical prescribing in multiple sclerosis: where does it fit into practiceMS Trust
This presentation by Linda Renfrew looks at evidence for non medical prescribing among allied health professionals, and how prescribing can be integrated into MS physiotherapy practice.
It was presented at the MS Trust Annual Conference in November 2014.
CMS Case Study_Brown and Toland Physician's Approach to Serving High Ris...marcus zachary
Brown and Toland Physicians developed a tiered care management program to improve health outcomes and lower costs for high-risk, high-cost patients. They identify these patients through predictive modeling, hospital visits, and physician referrals. Patients are provided different levels of care management based on their needs, including transitional care after hospitalization, outpatient care for chronic conditions, and home-based care for frail patients. This approach aims to address patients' medical and social needs through coordinated care across settings.
A review of the total knee replacement pathway: Integrated care is quality careApollo Hospitals
This document summarizes the implementation and results of a Total Knee Replacement clinical pathway at Apollo Health City facility in India. The pathway was adapted from a Canadian hospital and implemented in 2011. Key results included an increase in patient satisfaction from 56% to 77% and a reduction in average length of stay from 7.94 to 5.78 days over 45 months. Compliance with best practices like surgical site marking and DVT prophylaxis also improved. The pathway was evaluated using a standardized framework and found to improve clinical, service, team, process and financial outcomes for total knee replacement patients.
This study evaluated the effectiveness of a semi-tailored facilitator intervention to support implementation of chronic disease management programs in Danish general practices. 189 practices were randomly allocated to receive the intervention in 2011 or 2012. The intervention consisted of up to three one-hour visits from a facilitator to discuss topics related to chronic care. The primary outcome was the number of annual chronic disease checkups per patient. Secondary outcomes included use of diagnostic coding, patient stratification, and other process measures. Results showed no difference between groups for the primary outcome, but some secondary outcomes favored the intervention group, such as higher reported use of diagnostic coding and earlier signup for a patient management software. The authors concluded the low-intensity intervention was unlikely to substantially improve
The document summarizes research that shows clinical pharmacists play an important role in intensive care units (ICUs) by improving clinical outcomes and reducing mortality rates. Several studies cited found that ICUs with clinical pharmacist involvement had lower mortality rates, shorter hospital stays, fewer adverse drug events, and lower costs compared to ICUs without clinical pharmacist services. Direct involvement of pharmacists in ICU patient care was associated with reduced complications and improved outcomes for conditions like infections, bleeding, and sepsis.
Current State of Pain Management Services in Primary Care in the UKepicyclops
This lecture was given by Dr Martin Johnson, a General Practitioner from Barnsley, Yorkshire, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. This lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
www.wspg.org.uk
1115 aine carroll clinical leaders forum nhc integrated care turning healthca...investnethealthcare
This document summarizes a presentation on integrated care given at the National Healthcare Conference in 2015. It discusses different types of integrated care including horizontal, vertical, and within sectors. Integrated care aims to provide coordinated services across providers and settings to support patients. Barriers to integrated care include fragmentation, distrust, and lack of coordination between strategy and operations. National clinical programs in Ireland have led to improved outcomes for conditions like heart attacks, surgery, and stroke through more integrated models of care. However, challenges remain around resources, hierarchies, and fully implementing integrated approaches across the healthcare system.
This document discusses pharmacoeconomics, drug compliance, and therapeutic failure. It begins by defining pharmacoeconomics as the analysis of costs and consequences of pharmaceutical products and services. It then discusses various pharmacoeconomic methods like cost-benefit analysis and cost-effectiveness analysis. The document also explains drug compliance, adherence, and the consequences of non-compliance. It notes that non-compliance can result in therapeutic drug failure and increased costs. It concludes by discussing common interventions to improve compliance like patient education and simplifying drug regimens.
This document summarizes a patient satisfaction survey conducted at the Massachusetts General Hospital Cancer Center. It provides background on the importance of measuring patient satisfaction and assessing the interpersonal aspects of care delivery. The literature review discusses factors that influence patient satisfaction, such as health status, age, sex, and specific care experiences. It also describes common treatments for breast cancer and the challenges patients face. The document outlines the study's method, results, and discussion sections to evaluate patient satisfaction at the MGH Cancer Center clinic.
Muir Gray at the First National Conference on Health Care Quality RegistersTHL
The document discusses increasing value in healthcare systems through a "Triple Value Healthcare" approach. It proposes focusing on personal value for individuals, population value for given populations, and technical value through optimizing outcomes and resource use. Key strategies include providing full information to patients, shifting resources from overused to underused areas, developing population-based systems and networks, and creating a culture of stewardship. The goal is to improve outcomes while making the best use of limited resources.
This document describes a study that evaluated a new framework for end-of-life care and withdrawal of treatment on an intensive care unit. Staff completed questionnaires before and after the introduction of the framework to assess changes in knowledge, quality of care, and satisfaction. Results showed improvements in staff knowledge, increased confidence that patients' comfort needs were being met, and greater satisfaction with end-of-life care processes after implementing the framework. The study concludes the framework was associated with enhanced end-of-life care delivery and communication on the ICU.
This summarizes the outcomes of a 6-month pharmacist-provided diabetes management program for employees of the City of Toledo. The program showed improvements in clinical outcomes like A1c and blood pressure. It also improved humanistic outcomes such as patient satisfaction, knowledge, and adherence. Economic outcomes like healthcare utilization and costs improved as well, with a 62.69% reduction in total costs. The study demonstrates positive short-term outcomes across clinical, humanistic and economic domains from a pharmacist-led diabetes management program.
Making a difference: the benefits and challenges of non-medical prescribingMS Trust
This presentation by Dr Nicola Carey looks at the context of non-medical prescribing in the UK as well as its benefits and challenges.
It was presented at the MS Trust Annual Conference in November 2014.
This document summarizes key points from an IOM report on emergency care for children and discusses recommendations to improve pediatric emergency care readiness. It notes that children have unique medical needs that often aren't met in the emergency system. The three main goals discussed are coordination, regionalization, and accountability. Several recommendations are provided, including developing pediatric emergency care guidelines and competencies, appointing pediatric coordinators, improving safety, and enhancing family-centered and disaster preparedness.
This document discusses pharmacoeconomics and its importance in balancing the interests of stakeholders in the healthcare industry. It begins by defining health economics and pharmacoeconomics, and explaining their relationship. It then discusses the shift in focus of healthcare consumers towards disease prevention. The document outlines various challenges faced by the healthcare industry and how pharmacoeconomic solutions can address the perspectives of patients, physicians, insurers, manufacturers, researchers and policymakers. It provides a case study on drug selection for osteoarthritis using pharmacoeconomic analysis. Finally, it discusses the global presence and potential for establishing pharmacoeconomics in India.
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
The Effect of Protocol of Nursing Intervention on Quality of Care in Minor In...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
This article summarizes the results of establishing care pathways and an expert patient program for chronic conditions like diabetes, heart failure, and COPD in Barcelona, Spain. Key results include:
- Increased detection and monitoring of the conditions through improved protocols between primary and specialized care.
- Reduced hospital admissions and length of stay for heart failure patients.
- Increased patient knowledge and self-care through the expert patient program, which may have contributed to reduced heart failure admissions.
- High satisfaction among patients in the expert patient program.
1. Hospital statistics provide key information for health care decision-makers by analyzing clinical and financial data from hospitals. They summarize metrics like patient volumes, diagnoses, procedures, and revenue.
2. Core hospital statistics include administrative data on available beds, patient occupancy rates, and surgical volumes. Morbidity and mortality statistics track leading causes of illness and death by sex.
3. Calculating indicators such as average length of stay, bed turnover rate, and occupancy percentage helps monitor service delivery, plan facilities, and evaluate policies. However, hospital data only reflects patients seeking care and may not represent overall disease burdens.
This document reviews strategies to improve surgical outcomes through multimodal perioperative care approaches. It finds that newer perioperative care approaches have reduced both morbidity and mortality in surgical patients. Specifically, it discusses how regional anesthesia, minimally invasive surgery, intraoperative normothermia, and accelerated rehabilitation programs can reduce stress responses and complications after surgery. The major challenge is developing standardized "fast track" surgical programs using multimodal interventions to achieve pain-free and risk-free perioperative courses.
Non medical prescribing in multiple sclerosis: where does it fit into practiceMS Trust
This presentation by Linda Renfrew looks at evidence for non medical prescribing among allied health professionals, and how prescribing can be integrated into MS physiotherapy practice.
It was presented at the MS Trust Annual Conference in November 2014.
CMS Case Study_Brown and Toland Physician's Approach to Serving High Ris...marcus zachary
Brown and Toland Physicians developed a tiered care management program to improve health outcomes and lower costs for high-risk, high-cost patients. They identify these patients through predictive modeling, hospital visits, and physician referrals. Patients are provided different levels of care management based on their needs, including transitional care after hospitalization, outpatient care for chronic conditions, and home-based care for frail patients. This approach aims to address patients' medical and social needs through coordinated care across settings.
A review of the total knee replacement pathway: Integrated care is quality careApollo Hospitals
This document summarizes the implementation and results of a Total Knee Replacement clinical pathway at Apollo Health City facility in India. The pathway was adapted from a Canadian hospital and implemented in 2011. Key results included an increase in patient satisfaction from 56% to 77% and a reduction in average length of stay from 7.94 to 5.78 days over 45 months. Compliance with best practices like surgical site marking and DVT prophylaxis also improved. The pathway was evaluated using a standardized framework and found to improve clinical, service, team, process and financial outcomes for total knee replacement patients.
This study evaluated the effectiveness of a semi-tailored facilitator intervention to support implementation of chronic disease management programs in Danish general practices. 189 practices were randomly allocated to receive the intervention in 2011 or 2012. The intervention consisted of up to three one-hour visits from a facilitator to discuss topics related to chronic care. The primary outcome was the number of annual chronic disease checkups per patient. Secondary outcomes included use of diagnostic coding, patient stratification, and other process measures. Results showed no difference between groups for the primary outcome, but some secondary outcomes favored the intervention group, such as higher reported use of diagnostic coding and earlier signup for a patient management software. The authors concluded the low-intensity intervention was unlikely to substantially improve
The document summarizes research that shows clinical pharmacists play an important role in intensive care units (ICUs) by improving clinical outcomes and reducing mortality rates. Several studies cited found that ICUs with clinical pharmacist involvement had lower mortality rates, shorter hospital stays, fewer adverse drug events, and lower costs compared to ICUs without clinical pharmacist services. Direct involvement of pharmacists in ICU patient care was associated with reduced complications and improved outcomes for conditions like infections, bleeding, and sepsis.
Current State of Pain Management Services in Primary Care in the UKepicyclops
This lecture was given by Dr Martin Johnson, a General Practitioner from Barnsley, Yorkshire, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. This lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
www.wspg.org.uk
1115 aine carroll clinical leaders forum nhc integrated care turning healthca...investnethealthcare
This document summarizes a presentation on integrated care given at the National Healthcare Conference in 2015. It discusses different types of integrated care including horizontal, vertical, and within sectors. Integrated care aims to provide coordinated services across providers and settings to support patients. Barriers to integrated care include fragmentation, distrust, and lack of coordination between strategy and operations. National clinical programs in Ireland have led to improved outcomes for conditions like heart attacks, surgery, and stroke through more integrated models of care. However, challenges remain around resources, hierarchies, and fully implementing integrated approaches across the healthcare system.
This document discusses health technology assessment (HTA) and commissioning in the English NHS, with a focus on general practitioners (GPs). It provides background on HTA, which evaluates the clinical effectiveness and cost-effectiveness of health interventions. It also discusses key elements of the 2010 NHS reform plan and the history of GP commissioning in England since the 1990s, including GP fundholding schemes that gave GPs budgets to purchase some services. Evaluation found GPs were able to improve primary care and develop alternatives to hospital care, but faced challenges shifting resources from hospitals.
Medicines optimisation, pop up uni, 9am, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The document summarizes the evolution of the UK healthcare system and its experimentation with value-based approaches. It discusses:
1) The centralized NHS system and the influential role of NICE in determining cost-effectiveness of treatments.
2) Recent initiatives to introduce pay-for-performance models and identify variations in care pathways to increase value.
3) The challenges of clearly defining and measuring "value" given mixed results from these experiments and structural healthcare reforms that fragmented the system.
Seeking value: Experience from the UK's National Institute for Health and Car...OECD Governance
This presentation was made by Tommy Wilkinson, United-Kingdom, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
BPS SIGOPAC Bristol October 2016 - Liz Price : Commissioning Cancer As a Long...Alex King
The document provides an overview of cancer as a long term condition in London and strategies for commissioning related services. It finds that cancer prevalence is increasing and many patients experience long term physical, psychological and social effects. It advocates adopting a holistic long term conditions approach for cancer patients that includes implementing a recovery package, stratified follow up pathways, and addressing consequences of treatment. The document discusses collecting data on cancer patients, assessing population needs, involving stakeholders in service redesign, and using contracts to manage provider performance and quality of care.
1) The document summarizes recent reforms to the English National Health Service (NHS) proposed by the UK coalition government.
2) Key aspects of the reforms include transferring around 70% of the NHS budget to groups of general practitioners (GPs), increasing hospital autonomy and competition, and expanding patient choice.
3) The reforms aim to reduce central control over the NHS and introduce more market-based incentives, but also face significant implementation challenges and risks of disruption.
This document provides information on interventions that can help health systems achieve cost savings while delivering better quality care. It outlines eight high impact interventions that were identified from a literature review. For each intervention, it provides a summary case study, details of additional case studies, how the intervention impacts quality ambitions, and information on implementation. The eight interventions are: early diagnosis, reducing variability in primary care, self-management programs, telehealth/telecare, case management, rapid assessment of mental health, improving dementia care pathways, and palliative care.
Parallel Session 1.6.4 Managed Clinical Networks and Quality Improvement: A D...NHSScotlandEvent
The chronic pain service in Greater Glasgow and Clyde had issues with unequal provision and a lack of awareness in primary care. The Managed Clinical Network was established to streamline the patient journey, standardize care, and improve education and resources. It has led education programs, developed guidelines and websites, and established a pilot nurse-led clinic. Work continues on pathways, data collection, and addressing health inequalities.
Aine Carroll, National Director of Clinical Strategy & Programmes, HSEInvestnet
The document discusses the challenges of clinical leadership in Ireland and reforming the health system. It outlines why reform is needed, including improving service delivery through integrated models of care. It summarizes some of the achievements of Ireland's National Clinical Programmes in reducing wait times and lengths of stay for various conditions. It also discusses some of the problems within the current system like lack of integration and the need for reform of the clinical strategy and programmes division.
The document discusses lessons learned from reforms to the UK National Health Service (NHS) over time. Key points include ensuring incentives are aligned for all stakeholders, recognizing the impact of unnecessary structural changes, and taking an evidence-based approach to policymaking through piloting and gradual change. The Dutch healthcare system is presented as moving to a uniform insurance system in 2006 that is funded through payroll taxes, government subsidies, and individual premiums.
Graham was invited to the weekly seminar series by the Royal Brompton Hospital to deliver a presentation on health economics pertinent to Respiratory medicine. They care for a large number of patients with complex lung diseases at the institution and juggle the varied issues of resource (human, structural or financial). As one of many examples, high cost drugs for treating relatively unusual conditions comes up for debate all too frequently. The audience included consultant physicians, senior and junior trainees, nurses and other allied health professionals.
Date: 7 March 2019
Location: The Royal Brompton, London, UK
Selecting and Prioritizing Healthcare Projects by HTAanshagrawal2121
This document discusses selecting and prioritizing healthcare projects through health technology assessment (HTA). It provides examples of how HTA can be used to evaluate potential projects based on criteria like disease burden, cost-effectiveness, budget impact, and ethical considerations to help inform funding decisions. A case study examines using HTA to evaluate secondary prevention of heart attacks in the UK, finding that providing four specific drug classes met cost-effectiveness thresholds and had a manageable budget impact, leading to its inclusion in the national healthcare program. The document advocates that all countries could benefit from using systematic HTA processes to support more informed priority-setting and resource allocation decisions.
· Psychiatric Mental Health Nursing. Scope and Standards of Practi.docxoswald1horne84988
· Psychiatric Mental Health Nursing. Scope and Standards of Practice.
Review the Scope and Standards of Practice from APNA (American Psychiatric Nurses Association). If you are an APNA member you can access the book free of charge. The link in this section will link you to the book but you will have to log in. It is a good idea to join APNA. You can also buy a print copy if you desire; it is inexpensive. The book is not a required reading. I have provided the standards here.
The standards are taken directly from APNA Scope and Standards of Practice 2ndedition (2014).
Assignment for this module:
Take each Standard and give several examples of how you will follow these standards in your practice. Please, only list just a few bullet points to address each standard. Ex: Standard 1: Assessment—what screening tools will you use? Will you meet with the pt and family together or separate or both? How much time will you allow for a new patient eval?
As a NP will need to know your scope of practice. You cannot rely on someone else to know your scope.
Standard 1: Assessment
· Collect and synthesize comprehensive health data that are pertinent to the healthcare consumer’s health and/or situation.
Standard 2: Diagnosis
· Develop standard psychiatric and substance use diagnoses
Standard 3: Outcomes Identification
· Identify expected outcomes and the healthcare consumer’s goals for a plan individualized to the healthcare consumer or to the situation.
Standard 4: Planning
· Develop a plan that prescribes strategies and alternatives to assist the healthcare consumer in attainment of expected outcomes.
Standard 5: Implementation
· Implement the identified plan
· Coordinate care delivery
· Employ strategies to promote health and a safe environment
· Provide consultation to influence the identified plan, enhance the abilities of other clinicians to provide services for the healthcare consumers, and effect change.
· Use prescriptive authority, procedures, referrals, treatments and therapies in accordance with state and federal laws and regulations.
· Incorporate knowledge of pharmacological, biological, and complementary interventions with applied clinical skills to restore the healthcare consumer’s health and prevent further disability
· Provide structures and maintains a safe, therapeutic, recovery-oriented environment in collaboration with healthcare consumers, families and other healthcare clinicians.
· Use the therapeutic relationship and counseling interventions to assist healthcare consumers in their individual recovery journeys by improving and regaining their previous coping abilities, fostering mental health, and preventing mental disorder and disability
· Conducts individual, couples, group, and family psychotherapy using evidence based psychotherapeutic frameworks and the nurse-client therapeutic relationship
Standard 6: Evaluation
· Evaluate progress toward attainment of expected outcomes
Standard 7: Ethics
· Integrate ethical provisions in all .
This document describes a multipayer initiative in Pennsylvania to implement the patient-centered medical home model guided by the chronic care model for diabetes patients. 25 primary care practices with over 10,000 diabetes patients participated in the initiative. Practices received payments for transforming their practices and achieved improved clinical outcomes for diabetes patients in the first year, including better screening and treatment rates. This initiative represents one of the largest implementations of the chronic care model with payment reform across diverse practice types.
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This document provides guidelines for managing pain and symptoms in patients with incurable cancer or advanced disease. It addresses key symptom areas including pain, dyspnea, nausea, vomiting, constipation, delirium, fatigue, and depression. The pain management section outlines strategies for assessing and treating cancer pain, including the use of opioids, adjuvant analgesics, and non-pharmacological therapies. It provides algorithms and tables to guide clinicians in optimizing pain and symptom management.
Investing in specialised services - the prioritisation framework, pop up uni,...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Similar to Patients' access to cam in the nhs - an overview (20)
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
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TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
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This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
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Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
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2. Background
Nearly 40% of GP partnerships in England provide
access to CAM for NHS patients*1
one in ten of the population uses complementary
healthcare*2
three-quarters of the population would choose
complementary healthcare if it were available on the
NHS*2
Chronic musculoskeletal pain is the single most cited
reason for use of CAM*3
*1 Integrated Healthcare: A Way forward for the Next Five years? Published by the Foundation for Integrated
Health
*2 A Healthy Partnership – Integrating Complementary Healthcare into Primary Care; 2005 (published by the Prince
of Wales Foundation for Integrated Health
*3 The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain
(BMC Family Practice 2007)
3. Background
The benefits of unconventional therapies (aka CAM
therapies) on chronic pain,
their cost effectiveness
the need for CAM regulation and
the need for ongoing CAM research
have been recognised by health authorities in Scotland
and the rest of the UK since, at least, 1994
(‘Management of Patients with Chronic Pain’) all the way
to the SIGN guideline on chronic pain management
published in 2013.
This issue has been discussed for over 20 years
4. Background - Key documents recommending CAM
1994: The Management of Patients with Chronic Pain (Scottish
Government)
2000: The economic burden of back pain in the UK (‘Maniadakis Paper’)
2000: Services for patients with pain - Report of the Clinical Standards
Advisory Group Committee
2004: Chronic Pain Services in Scotland (‘McEwen Report’)
2006: Management of Chronic Pain in Adults (QIS)
2007: GRIPS report (Getting Relevant Information on Pain Services)
2008: Department of Health Steering Group (‘Pitillo Report’)
2009: NICE guideline (Early management of persistent non-specific low
back pain)
2013: SIGN Guideline on Management of Chronic Pain(#136)
5. Background - GUIDELINES
1999
NICE - ‘Early management of persistent non-specific
low back pain’:
5.1.4 Offer one of the following treatment options - taking into
account patient preference - an exercise programme, a course
of manual therapy or a course of acupuncture.
(Manual therapies in these guidelines are spinal manipulation,
spinal mobilisation and massage) The guideline also
recommends ‘Alexander Technique’
Evidence included “high quality systematic review with a very
low risk of bias” and other “well conducted RCT with a low risk
of bias”
6. Background - GUIDELINES
2013
SIGN ‘Management of Chronic Pain’ (#136):
7.1.1 Manual therapy should be considered for short term
relief of pain for patients with chronic low back pain
7.1.2 Manual therapy, in combination with exercise, should
be considered for the treatment of patients with chronic neck
pain. (grade 1++ evidence with a 'B' classification).
8.1 Acupuncture should be considered for short term relief of
pain in patients with chronic low back pain or osteoarthritis.
‘A' classification
‘Guidelines’ are developed making use of the best evidence
available and GPs are encouraged to follow them.
7. Current status of CAM referrals
Referrals to CAM therapist is supported by the
Government: “A GP or hospital clinician may refer a patient
for alternative treatment” [circular HDL(2005) 37]
BMA: “The BMA is supportive of those forms of
complementary therapy for which evidence of claims of
efficacy can be demonstrated”
GPs may delegate treatment to complementary therapists
who are not registered with a statutory regulatory body.
Dr Blair Smith (Scottish Lead Clinician for Chronic Pain):
“We also need to develop and review non-pharmacological
treatments, including psychological approaches, exercise
and activity, and complementary techniques such as
acupuncture.” (The Scotsman – 28th
March 2014)
8. Current status of CAM referrals
Government [circular HDL(2005) 37]
The GP or hospital clinician would require to
1. be satisfied of the value of the treatment and
2. the competence of the practitioner
3. and would remain responsible for the patient's
medical care
But support for CAM comes with certain conditions
In effect, GPs need to:
determine the evidence for the use of different forms of CAM for
different conditions as well as determine qualifications, insurance
status and safety/ethics of a therapist.
9. Current status of CAM referrals
GMC
you must be satisfied that systems are in place to assure
the safety and quality of care provided – for example, the
services have been commissioned through an NHS
commissioning process or the practitioner is on a
register accredited by the Professional Standards
Authority.
BMA
GPs may delegate treatment to complementary therapists who
are not registered with a statutory regulatory body. In doing so,
they remain responsible for the treatment given and would
bear some liability should the patient come to any harm.
But support has certain conditions
10. Current status of CAM referrals
“In terms of referral pathways, a GP referring to a CAM
would be considered as a TERTIARY REFERRAL under
the extra-contractual referral process (ECR)”
[NHS Lanarkshire]
A form is completed (for each patient) outlining
• the basic clinical details,
•the treatment (or sometimes investigation) proposed,
•the duration and an estimate of cost
Such referrals are considered by the Divisional Medical Director
The new Scottish service model for chronic pain (launched in 2013)
promotes the use of non-pharmacological treatments firstly within primary
care then, for more complex cases, secondary care. Never tertiary.
11. Inequality of access
The Government say that it’s up
to Health Boards to decide
whether to provide
unconventional therapies or not
Health Boards/GPs need regulation in order to comply with
conditions for non-statutory referrals.
Regulation is determined by the Government
NHS BOARDS
Can provide but
not regulate
GOVERNMENT
Can regulate
but not provide
Currently, access to CAM therapies recommended by
guidelines is dictated by how affluent patients are.
Equality can only exist if therapies are provided by the NHS.
12. INEQUALITY OF ACCESS – POSSIBLE SOLUTION
REGULATION
GPs could refer their patients to therapists registered with a
recognised national regulatory organisation, ideally
accredited by the ‘Professional Standards Authority’
CNHC (Complementary and Natural Health Care)
Originally funded by the Dept of Health in Whitehall
Created to regulate CAM in the whole of the UK
(much like the GMC regulate GPs)
Accredited by the Professional Standards Authority
Endorsed by the General Medical Council (GMC)*
13. INEQUALITY OF ACCESS – POSSIBLE SOLUTION
REFERRAL PATHWAY
Creation of a direct REFERRAL PATHWAY similar to other
existing mainstream services such as physiotherapy
WIDER DISSEMINATION OF INFORMATION
Making GPs, practice managers and other health
professionals (as well as patients) more aware of existing
chronic pain resources such as guidelines, chronic pain
website and the revised (2013) Scottish chronic pain service
model
ANY MORE?
e.g.
• dedicated ‘drug-free’ chronic pain clinics?
• dedicated Government funding?
14. Needed discussions
Matters related to the delivery of unconventional therapies through
the NHS need to be discussed - such as:
• central regulation of unconventional therapies (rather than
therapy-specific regulation)
• referral pathway
• delivery model
• cost effectiveness
• risk/benefit analysis
• possible integration within the MSK service
• use of unconventional therapies in the context of the GRIPS
and McEwen reports
• use of unconventional therapies in the context of human
rights and the ‘Patient Rights (Scotland) Bill’
• the desirability of continuous evidence assessment through
trials and audits (before research)
15. RESOURCES
CAM in the NHS: www.bit.ly/CAMintheNHS
Revised chronic pain model: Chronic Pain Services in Scotland
SIGN guideline #136: http://bit.ly/CPGuideline
NICE guideline CG88: www.nice.org.uk/guidance/CG88
Chronic pain support website: www.chronicpainscotland.org
Service Improvement Groups (SIGs): http://bit.ly/SIGsScotland
For further information or enquiries
paulo@intlifepain.org
Editor's Notes
*1 Integrated Healthcare: A Way forward for the Next Five years? Published by the Foundation for Integrated Health
*2 A Healthy Partnership – Integrating Complementary Healthcare into Primary Care; 2005 (published by the Prince of Wales Foundation for Integrated Health
*3 The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain (BMC Family Practice 2007 - Face-to-face interview-based survey )
1994:The Management of Patients with Chronic Pain (Scottish Government)
2000: The economic burden of back pain in the UK (‘Maniadakis Paper’)
2000: Services for patients with pain - Report of the Clinical Standards Advisory Group Committee
2004: Chronic Pain Services in Scotland (‘McEwen Report’)
2006: Management of Chronic Pain in Adults (QIS)
2007: GRIPS report (Getting Relevant Information on Pain Services)
2008: Department of Health Steering Group (‘Pitillo Report’)
2009: NICE guideline (Early management of persistent non-specific low back pain)
2013: SIGN Guideline on Management of Chronic Pain(#136)
McEwen Report – Recommendation 14
With regard to outcome evaluation the contribution of complementary therapy, long-term outcomes, patient functioning and rehabilitation could usefully be included and linked to international research.
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The Joint Commission *1 in the USA have just published "Revisions to pain management standard effective January 1, 2015" which makes non-pharmacological strategies (including Complementary and Alternative Medicine) a required integral part of chronic pain management standard. Their 'Standard PC.01.02.07 includes "Both pharmacologic and nonpharmacologic strategies have a role in the management of pain . . . Nonpharmacologic strategies: physical modalities (for example acupuncture therapy, chiropractic therapy, massage therapy . . .)"
*1 The Joint Commission (TJC) is a United States-based organization that accredits more than 20,000 health care organizations and programs in the United States. A majority of state governments recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement.
“No opioids or tricyclic antidepressants and only some NSAIDs have a UK marketing authorisation for treating low back pain.
If a drug without a marketing authorisation for this indication is prescribed, informed consent should be obtained and documented”
The SIGN guideline #136 shows that the evidence for manual therapies have
the same grading as some of the standard chronic pain drugs (eg gabapentin, Pregabalin and many others) - ie the grading is 1++
and are given a 'B' classification (the same as NSAIDs and strong opioids for low back pain, Lidocaine plaster, Carbamazepine, and better than CBT).
(1++ means High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias" - the highest level of evidence)
Re short term effect: Duloxetine 60 mg daily is effective in treating painful diabetic peripheral neuropathy in the short term to 12 weeks but is still prescribed in the NHS
Re efficacy of drugs: An often prescribed drug such as Tramadol, has only "a modest benefit compared to placebo" on lower back pain and "of unclear clinical benefit" and "one good quality review found no significant reduction in pain compared to baseline" and when opioids were compared to placebo or active controls there was limited evidence of efficacy".
SCOTTISH EXECUTIVE - Health Department - Public Health Division
NHS Circular: HDL(2005) 37
If an NHS Board sees a need for the provision of a particular type of CAM in its area it is open to that Board to provide that therapy, at the Board's discretion.
Recently the Executive made available to NHS Boards copies of a booklet produced by the Prince of Wales' Foundation for Integrated Health, Complementary Healthcare - A Guide for Patients.
Complementary and Alternative Medicine is an area in which there is increasing public interest. Chief Executives are asked to take this into account in the planning of services.
BMA
Whether GPs are prepared to delegate treatment in these circumstances would therefore depend principally upon their knowledge of, and belief in the efficacy of, the therapy and their personal knowledge of the competence of the individual therapist.
- they (GPs) need to be satisfied that the individual (therapist) is suitably qualified and experienced to undertake the role.
- GPs should also be aware that, in such circumstances, they may be held liable for any harm arising to their patients
- ensure that tasks are delegated only to those who are competent to fulfil them satisfy themselves that the treatment seems appropriate to the patient’s needs and is likely to benefit the patient. As above, this presupposes some knowledge of, and belief in the efficacy of, the therapy.
--------------------------------------------------------------------
General Medical Council (GMC) 2015
7. Usually you will refer to another doctor or healthcare professional registered with a statutory regulatory body.
8. Where this is not the case, you must be satisfied that systems are in place to assure the safety and quality of care provided – for example, the services have been commissioned through an NHS commissioning process or the practitioner is on a register accredited by the Professional Standards Authority.
A form is completed outlining
the basic clinical details,
the treatment (or sometimes investigation) proposed,
the duration and an estimate of cost.
Such referrals are considered by the Divisional Medical Director
In a ‘real life’ situation, one of my local GPs in South Lanarkshire was asked if she would refer one of her patients for massage therapy for his low back pain as he had heard that it was recommended in the chronic pain guideline.
When she told him that she would have to write to the Health Board who, in turn, would consider her request at their next meeting some time in the future and would then decide whether they would approve the request or not (and under what conditions) and write back to the GP, the patient decide that he couldn’t wait that long and withdrew his request.
There was a significant positive association between CAM use and non-manual social class and gross income over £15 600 (Results from the National Omnibus survey 2004)
“We often talk in the Parliament about joined-up talking and thinking. Surely pain management is an excellent example of a service that could span the NHS and the independent sector as well as complementary medicines” Mary Scanlon MSP [Scottish Parliament Official Report, 27 February 2002, Col 9753]
“With NHS Lanarkshire budget constraints our concern would be that referrals would essentially be blocked for CAM therapy and not receive board approval”
(local GP practice)
The use of unconventional therapies both in acute and chronic pain management as a first-line approach choice at primary care level together with conventional approaches would have the benefit of freeing valuable specialist resources for more complex cases. [Services for Patients with Pain - 1 84182 157 8] This view is also supported by the Clinical Standards Advisory Group statement that “It is important to recognise that only a minority of patients with pain will need treatment by specialist pain services”.
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Drugs are often not effective and can have extreme negative side-effects:
There are around 65,000 gastrointestinal haemorrhage emergencies a year in the UK as adverse effects from NSAIDs (Ibuprofen, aspirin, etc) (NSAIDs and adverse effects: Bandolier); Vioxx killed at least 60,000 people before it was withdrawn;
in September 2011 it was discovered that Diclofenac and other common pain killers/anti-inflammatories increase the risk of stroke and serious heart problems by 40% (just 5% below the risk associated with Vioxx);
In the USA, the FDA have ordered lower doses of Acetaminophen in prescription painkillers (used for headaches, aching muscles and sore throats) as it has been the leading cause of liver failure in the USA being estimated to be directly responsible for some 120 deaths a year;
GPs could refer their patients to therapists registered with a recognised national regulatory organisation, ideally accredited by the ‘Professional Standards Authority’
This organisation would have a central database of ‘safe’ therapists who were pre-screened and have all the requisites to practice
------------------------------------------------------------------------
“Physical treatments such as massage [should be] made available on the NHS and much quicker access (possibly in partnership with funding existing providers)”. Dr Marilyn McNeill (Pain Concern) [What I want to achieve: Cross Party Group on Chronic Pain Comments (2007)]
Complementary therapies make an enormous contribution and should be developed. Patients are at risk if they do no understand that Chronic Pain is a condition in it’s own right. Patients in most circumstances have to pay for therapy and shouldn’t do this. (Liz McLeod – Chair of Physiotherapy at Pain Association and advisor to Pain Concern - CPG meeting June 2002)
------------------------------------------------------------------------------------------------
HUMAN RIGHTS: In ‘‘Getting it right? Human rights in Scotland’ , the Scottish Human Rights Commission state that “Health facilities, goods and services have to be accessible to everyone without discrimination”.
And that this has four dimensions:
non-discrimination (in law and fact),
physical accessibility
economic accessibility and
information accessibility.
The same document by the SHRC also states that
“Participation in decision-making and legal capacity is pivotal to the realisation of an individual’s dignity and rights”.
“The freedom to accept or refuse specific medical treatment, or to select an alternative form of treatment, is vital to the principles of self-determination and personal autonomy”
Matters related to the delivery of unconventional therapies through the NHS need to be discussed - such as:
central regulation of unconventional therapies (rather than therapy-specific regulation)
referral pathway
delivery model
cost effectiveness
risk/benefit analysis
possible integration within the MSK service
use of unconventional therapies in the context of the GRIPS and McEwen reports
use of unconventional therapies in the context of human rights and the ‘Patient Rights (Scotland) Bill’
the desirability of continuous evidence assessment through trials and audits (before research)
----------------------------------------------------------------------------------
In 1998, Congress established The National Center for Complementary and Alternative Medicine (NCCAM) as a branch of the National Institute for Health’s (NIH) Office of Alternative and Complementary Medicine.
The NCCAM was created to
fund research to study the effects of CAM on various illnesses;
explore CAM practices within a rigorous, scientific context;
train CAM researchers;
and to disseminate authoritative information.
The budget of the NCCAM is $100 million, funding several large clinical trials and supporting fifteen specialized research centres.