Dispensary Review of use of Medicines (DRUM)
This is a review with patients of their compliance with their use of medicines. We will be asking patients to take part in a short questionnaire over the next few months. This will involve a face to face review with patients regarding their use and storage of prescription and over the counter medicines. This will be recorded in the patient’s medical record. The aim is to improve the clinical and cost effectiveness of prescribed medicines, recommend improvements in repeat dispensing and help to reduce medicines wastage. This should take no longer than ten minutes. We would appreciate your co- operation
Summary Care Record
The NHS in England is changing the way your health records are stored and managed.
Today, records are kept in all the places where you receive care. These places can usually only share information from your records by letter, email, fax or phone. At times, this can slow down treatment and sometimes information can be hard to access.
By making more health records electronic, there will be quicker ways to get important information to NHS healthcare staff treating you, including in an emergency.
The Summary Care Record is an electronic record which will give healthcare staff faster, easier access to essential information about you, to help provide you with safe treatment when you need care in an emergency or when your GP practice is closed.
All practices in Suffolk have now gone live with the Summary Care Record project. Summary Care Record will be used to support your emergency care as it will give healthcare staff faster, easier access to essential information about you when the surgery is closed or in an emergency i.e. if you go to A&E.
If you would like further information about SCR and your choice either phone Health and Social Care on 0845 3006016 or visit this website.
Preventing strokes in the community
Preventative medicine is a large part of the GP's role and explaining the importance of this to patients is a daily event. In stroke, we know that blood pressure control is crucial and diabetes, smoking and obesity are other important factors which can load the dice and affect the risk of stroke in an individual. Of course age and family history are fixed risks that can mean the variable ones become even more important.
Less newsworthy is the fact that about 30,000 of the 110,000 strokes that occurred last year happened in patients who had a heart condition called Atrial Fibrillation (AF). This is quite common (1.4% of the population but 10% of the over 80s) and it causes an irregular pulse that makes the formation of tiny clots in the heart more likely. In fact patients with AF are four times more likely that those with normal rhythms to have a stroke. AF usually causes absolutely no symptoms at all and so part of the challenge is to find these patients and then try to reduce their risk of stroke.
Finding new patients with AF
GPs and Nurses can do their own screening on everyone who attends the Surgery. But taking a pulse and finding if it is irregular is something that anyone can do. If there is any doubt then the pulse can be checked by a Nurse or a Doctor and if necessary a confirmatory ECG can be done. We know from work elsewhere that there are about 60% more patients with AF than we are aware of and we want to identify and help them.
The best treatment in most cases is to use warfarin (the clot- stopper) and sometimes to control the heart rate. Warfarin is very effective but it does have drawbacks. Firstly it makes bruising and bleeding more likely because it slows down natural clotting. In some patients there is a balance of risk that suggests avoiding warfarin is the right thing to do - but these cases are relatively rare. There is no doubt that these are 'rock and hard place' decisions because in 1000 patients we know that six will have bleeds (with occasional fatalities) and yet 30 will have strokes. As GPs, our dilemma is that our warfarin treatment could rarely cause death and yet not treating is generally much more likely to cause death or disability - and yet this might be seen by the public as 'natural'. A frequent compromise is the prescription of Aspirin which may save 12 strokes but the contention is that we should warfarinise more patients.
Why not warfarinise more patients with AF?
The decision here weighs up a lot of factors. The risk of falls and subsequent bleeds, difficulty in getting the warfarin dose blood tests and uncertainty about whether patients will take the warfarin reliably are reasons quoted frequently by GPs. Occasionally the risks of treatment are given more emphasis than the risks of not treating although sometimes it is clearly right not to treat.
Patients and their relatives need to be aware of this balance so that mature decisions can be made. We now have a computer programme that can predict the annual risk of stroke while the patient is sitting in the Consulting Room. We know patients are more concerned about stroke than heart attack so this will be powerful personal information that will influence the decision that the patient and GP take together. Furthermore the patient information is also checked by a local Cardiologist who gives an emailed response within a day based on the information supplied. This is a new move which will support both GPs and patients in difficult decisions. In Primary Care we need to make the blood testing easier and have this done in the home by someone who specialises in just warfarin. He or she can then help patients be clear about dosages possibly even using a portable machine in the home.
Sexually active young people who live in Suffolk and are under the age of 25 years of age are being encouraged to find out if they have a sexually transmitted infection (STI) called Chlamydia and to take a test every year or every time you change sexual partners. Remember - chlamydia may not have any signs or symptoms but it is estimated that 1 in 12 sexually active young people have the infection. It can cause long term health problems including infertility. Testing is simple and painless - no unpleasant examination or swabs and it is easily treated with antibiotics
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