Abstract
Checkland K, Snow S, McDermott I, Harrison S, Coleman A
J Health Serv Res Policy 2012;17(1):11–17
Over the next few months, general practitioners in England will be taking more responsibility for commissioning health services for their patients, probably within newly created Clinical Commissioning Groups. This study of the way managers in the existing Primary Care Trusts have behaved, contains lessons for GPs as commissioners. They will need a deep understanding of the ways the whole healthcare system works. They will need to ensure that the multiple organizational layers and lack of clarity as to how decisions get made do not obstruct their goals. One successful type of commissioning manager identified in this study is designated the ‘animateur’ – someone who successfully manages disparate groups over whom they don't actually have any formal authority. This is almost certainly going to be a feature of the situation that GPs find themselves, in the brave new world that awaits them.
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Mulvaney SA, Anders S, Smith AK, Pittel EJ, Johnson KB
J Telemed Telecare 2012; published ahead of print, doi:10.1258/jtt.2011.110006
A photographic foot imaging device (PFID) may help prevent complications in high-risk patients with diabetes by enabling early diagnosis of foot disease. Hazenberg et al., from the Netherlands, developed a device to provide high-quality digital photographs of the plantar surface of the foot. They investigated the use of the device to detect early signs of foot disease in patients with diabetes. Images of the plantar foot were taken three times a week over a period of four months in the homes of 22 high-risk patients. The images were automatically transmitted to a server, and remotely assessed by a diabetic foot specialist. During the study, all three referrals for diagnosed ulcers and 31 of 32 referrals for abundant callus resulted in treatment. Health-related quality of life (EQ-5D), increased from 7.5 at baseline to 7.9 at the end of follow-up, although not significantly.
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Good DW, Lui DF, Leonard M, Morris S, McElwain JP
J Telemed Telecare 2012; published ahead of print, doi:10.1258/jtt.2011.011814
Orthopaedic researchers in Dublin found that using Skype allowed them to carry out functional assessments of patients at home. This overcame the reluctance of patients to return to hospital for review – 93% of patients assessed with both methods preferred the use of Skype to outpatient review. Most of the Dublin patients (83%) already had the necessary equipment at home and the Skype software is free. A careful laboratory study showed that Skype could be used to measure range of motion of the shoulder joint accurately and therefore can determine functional outcome scores such as the Constant shoulder score. It is increasingly important for surgeons to audit the outcome of their work and Skype provides an additional option for follow-up.