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Q: How do older people make decisions about cataract surgery?
The British government has proposed speeding up the rate of cataract operations by giving surgeons in training their own operating lists. But operations done by junior doctors carry with them a greater risk of complications. In this study, based in Nottingham, researchers examined the attitudes of 146 patients aged between 60 and 84. They asked them to rank 11 different “cataract surgery packages”, each of which had a different combination of waiting time, grade of surgeon and risk of complications. Some respondents were particularly worried about the risks, while others were more worried about the waiting times. The authors suggest that patients should be given the option of having their operation done more quickly by a junior doctor: “We recognise that this is a radical proposal, but it is one that is consistent with being open with patients and with offering them choices in their health care”. See page 13
▸ ACTION POINT
Some patients may be willing to go on a junior doctor’s surgery list if it means that they will be operated on more quickly.
Q: Do audits measure the right things?
A group of British investigators developed a tool for measuring the extent to which those carrying out audits used a systematic approach to select criteria. They sent their Audit Criteria Questionnaire to 10 audit leads in 83 randomly selected NHS trusts and all practices in each of 11 randomly selected primary care audit groups in England and Wales. The mean score for all groups was 0.54, but these ranged from 0.0 to 0.93. The methods of selecting review criteria were “often less systematic than is desirable”, say the authors. As well as advocating wider use of their questionnaire, they suggest investment in training, protected time, better access to literature, more support staff, and making published protocols more widely available. See page 24
▸ ACTION POINT
We need to select review criteria more systematically if we are to bring about not just change, but a real improvement in quality.
Q: Can measures of quality of care be transferred between countries?
Quality indicators are increasingly being used to measure quality of health care, particularly in the United States. In this study investigators from both sides of the Atlantic took one set of measures used in US primary care (the RAND-UCLA appropriateness method) and developed them for primary care in the UK. Out of 174 indicators covering 18 conditions, over half (56%) had exact or near equivalents in the UK context. “We believe that there is considerable scope for countries to collaborate in the development of quality indicators, particularly countries with similar health systems such as the UK and the Netherlands”, write the authors. “Nevertheless there will always be important contextual differences between countries which mean that indicators cannot be transferred from one country to another without going through a process of modification”. See page 8
▸ ACTION POINT
Measures of quality of care developed in one country should be carefully reviewed before being applied to another.
Q: What can we do about high prescribing GPs?
Prescribing costs for some GPs in the UK are twice as much as those for others. In this study, researchers sent a questionnaire to 1714 GPs in the upper, middle and lowest quintiles. They used multivariate analysis to show that GPs with high prescribing costs were more likely to be single handed, do their own dispensing, and serve low income populations. They were also more likely to see drug reps, to prescribe newly available drugs, and to prescribe more readily to patients who expected a prescription. They were frustrated at te lack of time available for consultation and dissatisfied with their review methods for repeat prescribing. They were less likely to find criticism by colleagues useful and to use the BNF. The authors comment: “The results of our study provide the basis on which change programmes can be developed rationally on a basis of educational needs”. See page 29
▸ ACTION POINT
It should be possible to set up rational programmes to educate high prescribing GPs.
Compiled by Tim Albert
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