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Patients with multiple conditions not getting best possible care, say experts

Reported in The Guardian (19 April 2018): Too often patients are treated by a raft of different specialists when they should be treated more holistically

Millions of people in the UK and many more across the world are suffering from multiple long-term illnesses and may not be getting the best possible treatment from health services that focus on one disease at a time, say experts.

A team from the Academy of Medical Sciences in the UK says this is a growing problem and a huge potential burden on the NHS and other health services. “Clusters” of diseases are becoming more common, they say, such as type 2 diabetes, high blood pressure, osteoarthritis, depression and chronic obstructive pulmonary disease of the lungs.

Specialised hospital doctors treat each one of these conditions individually. Patients may have one problem treated and then have to wait months to see a different specialist for another condition. The experts are calling for a greater role for the GP, who can look at the whole person, but needs more time than a 10 minute consultation.

Prof Stephen MacMahon, principal director of the George Institute for Global Health and chair of the Academy’s steering group on multimorbidity said the best evidence on the numbers came from Australia, but there was no reason to think other countries would be different. “Among Australians seeing a general practitioner, half have two diseases or more, a third have three or more and 10% have six diseases or more,” he said. “This is not a small problem.”

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The Clinical Trial Is Open. The Elderly Need Not Apply

The New York Times (13 April 2018): 

Geriatricians have complained for years that figuring out treatments for their patients becomes dramatically more difficult when older people are excluded from clinical trials and other research.

For an 83-year-old, what are the risks and benefits of a surgical procedure, drug or medical device tested primarily on those in their 50s? When a drug trial excludes those who have several diseases and take other drugs, how do the results pertain to older adults — most of whom have several diseases and take other drugs?

Too often, doctors resort to extrapolation — or, to put it less politely, guessing.

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EAMA: Advanced postgraduate Course 2019-20

The European Academy for Medicine of Ageing (EAMA):  Advanced Postgraduate Course 2019-20

The European Academy for Medicine of Ageing is an Advanced Postgraduate Course in Geriatrics.

The EAMA’s goals are to:

  • Improve knowledge and skills in geriatric medicine for junior faculty members and promising candidates for future teachers in geriatrics
  • Attune the attitudes and goals of future opinion leaders in geriatric medicine throughout Europe
  • Establish a network among medical doctors responsible for the care of elderly persons and those responsible for student instruction
  • Develop new ideas for geriatric health programmes and harmonise practices
  • Encourage scientific interest in gerontology and geriatrics at local, national and international levels.

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2018 End of Life Care

The powerpoint files supporting presentations at the BGS 2018 End of Life Care conference are now available for download. We publish only those files which have been authorised for publication by the authors. The files are published in secured pdf format to obviate plagiarism as far as this is possible. (updated 28 March 2018)

Adrian Hopper: AMBER Care Bundle

Adrian Treloar: Joined up care; lessons for dementia

Dawn Moody: Using population sub-segmentation to promote tailored end of life care in later life

Caroline Nicholson: Attending to living and dying: improving end of life care for older people with frailty in the community

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Sustainability and transformation in the NHS Contents

The Department of Health and Social Care (the Department) is ultimately responsible for securing value for money from healthcare services. It sets objectives for the NHS through an annual mandate to NHS England and in 2016–17 gave it £105.7 billion to plan and pay for services and patient care delivered by the NHS. NHS England allocated the greatest share of this budget to 209 clinical commissioning groups, which largely bought healthcare from 235 hospital, community and mental health trusts. Trusts manage their expenditure against the income they receive, while NHS Improvement oversees and monitors the performance of trusts. The Department has made NHS England and NHS Improvement responsible for ensuring the NHS balances its budget.

In 2016–17, NHS England, clinical commissioning groups and NHS trusts and NHS foundation trusts (trusts) reported a combined surplus of £111 million against their income, a significant improvement compared to the combined deficit of £1,848 million they reported in 2015–16. This improvement was the direct result of the Department’s £1.8 billion Sustainability and Transformation Fund, paid by NHS Improvement to trusts for meeting financial and performance targets. Without this Fund, the combined financial position of the NHS would have been only slightly better than in 2015–16. As well as balancing its books each year, the NHS needs to invest in new ways of working that can better serve the changing needs of patients and increasing demand for services. To facilitate a more long-term approach to achieving sustainability, local partnerships of commissioners, trusts and local authorities have been set up to develop long-term strategic plans and transform the way services are provided more quickly.

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