Family Medicine Update

Treatment of patients with pulmonary embolism entirely in Hospital in the Home.

Aust Fam Physician. 2007 May;36(5):381-4

Authors: Lui B, Tran A, Montalto M

BACKGROUND: Low molecular weight heparin (LMWH) has revolutionised the management of venous thromboembolism (VTE). An important feature of the use of LMWH is the ability to manage acute VTE in the home. This study examined the outcomes of patients with pulmonary embolism (PE) who were transferred to Hospital in the Home (HIH) within 24 hours of presentation for treatment with LMWH. METHODS: The authors reviewed records of all patients with PE who presented to two major hospitals in Melbourne (Victoria) and who were transferred to HIH for treatment with LMWH within 24 hours of presentation. The main outcome measures were length of stay, unexpected staff callouts, unexpected returns to hospital, recurrent embolism, bleeding, and death. RESULTS: Twenty-one patients were included in the study over 5 years, with a mean age of 56 years. Patients spent a mean of 9 hours in hospital before transfer and spent a mean of 6 nights in HIH. One patient required an unexpected staff callout. There were no unexpected returns to hospital. No patient deaths or instances of major bleeding were recorded. Three patients developed minor bleeding. DISCUSSION: Despite the long study period, this is a small cohort of patients and no control group is offered. However, all eligible patients were included in the study. With appropriate risk assessment and medical model of HIH, it might be safe to treat low risk patients with PE in HIH for their entire hospital stay.

17492079

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The quality of a surgeon defined by internal medicine and family practice physicians: a closed-ended survey with importance scale.

Am Surg. 2007 May;73(5):481-3

Authors: Frezza EE, Wachtel MS

An anonymously completed, closed-ended questionnaire with an importance scale was sent to physicians to assess which qualities were important in their selection of a surgeon. Differences in proportions of rankings that were designated “extremely important” were assessed by binomial logistic regression was used. Null hypotheses were rejected if P < 0.05. Forty-two of 61 questionnaires were returned for analysis. Differences between dependability and other characteristics were statistically significant (G = 35.62, P = 0.001). The only characteristics that were statistically significantly less likely to receive a ranking of “extremely important” were facility appearance, subspecialty fellowship, and graduation from a good residency. All other differences could have been explained by chance (P > 0.05). Surgeons’ character, equipment, and staffing of the facility were ranked extremely important, whereas training of the surgeon or the appearance of the facility was not.

17521004

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Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care.

J R Soc Med. 2007 Jun;100(6):275-83

Authors: Millett C, Car J, Eldred D, Khunti K, Mainous AG, Majeed A

Objective To examine the association between practice list size, deprivation and the quality of care of patients with diabetes. Design Population-based cross-sectional study using Quality and Outcomes Framework data. Setting England and Scotland. Participants 55 522 778 patients and 8970 general practices with 1 852 762 people with diabetes. Interventions None. Main outcome measures Seventeen process and surrogate outcome measures of diabetes care. Results The prevalence of diabetes was 3.3%. Prevalence differed with practice list size and deprivation: smaller and more deprived practices had a higher mean prevalence than larger and more affluent practices (3.8% versus 2.8%). Practices with large patient list sizes had the highest quality of care scores, even after stratifying for deprivation. However, with the exception of retinal screening, peripheral pulses and neuropathy testing, differences in achievement between small and large practices were modest (<5%). Small practices performed nearly as well as the largest practices in achievement of intermediate outcome targets for HbA1c, blood pressure and cholesterol (smallest versus largest practices: 57.4% versus 58.7%; 70.7% versus 70.7%; and 69.5% versus 72.7%, respectively). Deprivation had a negative effect on the achieved scores and this was more pronounced for smaller practices. Conclusion Our study provides some evidence of a volume-outcome association in the management of diabetes in primary care; this appears most pronounced in deprived areas.

17541098

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