eLetters

118 e-Letters

  • Prescribing costs of dispensing doctors
    Michael Wilcock

    Dear Editor

    Watkins and colleagues[1] add to the growing literature on the many and varied influences on general practitioner prescribing behaviour and costs.[2,3] They argue, from the results of their analyses, that the dispensing status of the general practitioner is a statistically significant predictor associated with high prescribing costs, though it is unclear from their report exactly how many dispensing pract...

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  • GRiP: did it have an effect?
    Nick A Black

    Dear Editor

    Milne and Hill suggest the 'Getting Research into Practice' programme may have contributed to the decline in surgery for glue ear that we have reported. We cannot, however provide any evidence to support this suggestion. The rate of decline in surgery throughout England was similar to that observed in 13 former health districts in the Oxford/Anglia region. The ratio of change in rates after 1992 over the...

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  • Guidelines can be derived from research into quality programmes
    John A Ovretveit

    Dear Editor

    I would like to thank Dr Checkland for her thoughtful comments on our paper about evaluating quality programmes. I have some sympathy with her views and for the intriguing proposal about research in this area which she makes. I would agree that insufficient attention has been given to how features of organisations described in organisational theory influences how quality programmes are carried throu...

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  • Quality improvement programmes: time for a rethink?
    Kath H Checkland

    Dear Editor

    I read the paper by Ovretveit and Gustafsen with interest, as I believe that this is a neglected area. I found their paper admirably clear and concise, and I would agree with many of their points. However, I feel that they have neglected one important area.

    In their discussion of the ways in which this kind of research could be improved, they discuss the need for empirically based explanatory theo...

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  • Response to Milne and Hill
    Nick A Black

    Dear Editor

    Milne and Hill raise an interesting hypothesis - that the decline in surgical rates may have been due to a programme of Getting Research Into Practice. We intend to test this hypothesis by comparing our data with that for the whole of England and, within the area of our study, to compare the two Berkshire districts with districts in the former East Anglian region. We will report the results on this site...

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  • GRiP and the decline in surgery for glue ear
    Ruairidh Milne

    Dear Editor

    Black and Hutchings present an intriguing account of the rise and fall of glue ear surgery in two English regions.[1] They speculate that the acceleration of the decline from 1992 may have been due to the Effective Health Care bulletin on glue ear, helped by five "contextual features". One of these was the concurrent structural change to the NHS, arising from the introduction of health care commis...

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  • Re: Important practical limitations for decision support
    Alan H Morris

    Dear Editor

    Dr Shojania raises important issues that must be solved before widespread implementation of many decision-support tools is possible. I appreciate his letter. Dr Shojania and I, however, have been addressing different kinds of decision-support. The tools my colleagues and I have implemented, both locally and at external sites, are explicit tools that generate specific instructions, in contrast to...

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  • Agreement with new paradigm for RM
    Mary E. Gutman, MS, CPHRM

    Dear Editor

    I very much agree with the authors concerning the role of Risk Management in the Patient Safety arena. In fact, as a Director of Risk Managment in an integrated delivery system in Dayton, Ohio, I have been very involved in the patient safety efforts of our two acute care organizations, as well as the other entities within our system. My concern for the past few months has been how to best focus the ri...

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  • Important practical limitations for decision support
    Kaveh G. Shojania

    Dear Editor

    I share much of Dr Morris' enthusiasm for decision support. While involved in an evaluation of a decision support targeting vancomycin ordering practice,[1] I had the opportunity to observe the potential impact of this approach. However, as a clinician using the same computerized order entry system in daily practice, I also recognized the major limitation of this approach: users will not tolerate many...

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  • Quality in nursing and health care: resources available
    Ann C Brokenshire

    Dear Editor

    As a member of the professional organisation for nurses in Ontario, I would like to direct nurses and other interested readers to the web page of the Registered Nurses Association of Ontario, www.rnao.org

    This site has a wealth of position statements, policies, submissions to a variety of health stakeholders and other documents relating to providing...

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