PubMed Health⌕ Search

Biomedical subjects

Aneez Esmail

Publications and source records attributed to Aneez Esmail.

13 recordsLinked to original sources
PubMed2006

Learning from litigation. The role of claims analysis in patient safety.

Claims for malpractice and medical negligence are a potentially important source of information on the causes of harm to patients and have provided valuable lessons in the past. However today, with many additional sources of information and methods of analysis, the role of claims analysis needs to be reappraised. We consider the role of claims analysis in relation to other methods of studying adverse outcomes, review previous studies of claims and summarize the findings of four recent British specialty claims reviews. Claims analysis has a number of inherent limitations. We suggest that there is now no case for ad hoc claims reviews which rely on data that have been assembled for legal purposes only. Claims review is still potentially useful for rare events or in cases where other sources of data are not available. However, future claims reviews need to meet basic criteria before being undertaken; these include prospective identification of the relevant questions and variables, adequacy and completeness of the data set, availability of expert reviewers and clear protocols for review.

Health Services Research↗
PubMed2005

Managing risk: a taxonomy of error in health policy.

This paper discusses the current initiatives on error and adverse events within healthcare, with a particular focus on the NHS, within the context of health policy. One of the key features of the paper is the proposal for an emergent taxonomy of the medical error literature, developed from the ideologies and rationales that underpin their approaches. This taxonomy provides details of three categories--empiricists, organisational rationalists and reformers of professional culture--and these act as an organising framework for the exploration of the potential consequences of current policy on errors and adverse events. This discussion highlights the tension between optimising health outcomes for patients and managing the health system as effectively as possible. In particular, the inherent tension between explicit managerial formulations of risk and implicit risk management strategies associated with medical professionalism are considered.

Classification↗
PubMed2005

Randomised controlled trial of a hypothyroid educational booklet to improve thyroxine adherence.

BACKGROUND: Non-adherence with medication prescribed for chronic disease is ubiquitous and undermines the benefits of effective therapy. AIM: To evaluate the influence of an educational booklet on thyroxine adherence and health in patients with primary hypothyroidism. DESIGN OF STUDY: Unblinded randomised clinical trial of individual patients (by stratified permutated blocks) to receive an 'educational booklet' or 'usual care'. SETTING: Three general practices in the north-west of England serving 497 adults with primary hypothyroidism (prevalence 1.5%). METHOD: A total of 332 adults who had been prescribed thyroxine for hypothyroidism were allocated to either a group that was posted a hypothyroid booklet addressing lay health beliefs or to a group that received usual care. Outcomes were mean within-subject change over 3 months in thyroid stimulating hormone (TSH), the SF-36 domains of vitality and general health, and a hypothyroid symptoms index. All results were concealed until the end of the trial. RESULTS: A total of 332 randomised patients were analysed by 'intention to treat' (TSH available for 330 patients). Groups were comparable at baseline, although 'undetectable TSH' was higher in the intervention than the control group (20% versus 13%). Mean change in TSH was -0.11 mIU/L (intervention) and -0.12 mIU/L (control). An absolute difference of 0.01 mIU/L (95% confidence interval [CI] -0.93 to 0.94 mIU/L). Analysis adjusted (ANCOVA) for baseline TSH produced a difference of -0.12 mIU/L (95% CI = -1.97 to 1.95). Changes in SF-36 and hypothyroid index were minimal. Trial participants were younger than non-participants and more likely to have a previous TSH in the normal range. CONCLUSION: Brief intervention with an educational booklet has no influence on thyroxine adherence or health in patients with primary hypothyroidism. These findings do not support the routine distribution of health educational materials to improve medication adherence.

Female↗
PubMed2003

The frequency and nature of medical error in primary care: understanding the diversity across studies.

BACKGROUND: The identification and reduction of medical error has become a major priority for all health care providers, including primary care. Understanding the frequency and nature of medical error in primary care is a first step in developing a policy to reduce harm and improve patient safety. There has been scant research into this area. OBJECTIVES: This review had two objectives; first, to identify the frequency and nature of error in primary care, and, secondly, to consider the possible causes for the diversity in the stated rates and nature of error in primary care. METHODS: Literature searches of English language studies identified in the National Patient Safety Foundation bibliography database, in Medline and in Embase were carried out. Studies that were relevant to the purpose of the study were included. Additional information was obtained from a specialist medico-legal database. RESULTS: Studies identified that medical error occurs between five and 80 times per 100000 consultations, mainly related to the processes involved in diagnosis and treatment. Prescribing and prescription errors have been identified to occur in up to 11% of all prescriptions, mainly related to errors in dose. There are a wide variety of definitions and methods used to identify the frequency and nature of medical error. Incident reporting, systematic identification and medico-legal databases reveal differing aspects, and there are additional perspectives obtained from GPs, primary health care workers and patients. CONCLUSION: An understanding of the true frequency and nature of medical error is complicated by the different definitions and methods used in the studies. Further research is warranted to understand the complex nature and causes of such errors that occur in primary care so that appropriate policy decisions to improve patient safety can be made.

Communication↗
PubMed2002

An analysis of practice-level mortality data to inform a health needs assessment.

BACKGROUND: The utility of practice death registers has been indicated but, in the wake of the recent Harold Shipman case in the United Kingdom, the value of individual practice-level analysis has been questioned. AIM: To assess the value of analysing practice-level mortality data to inform health needs assessment. DESIGN OF STUDY: Comparative analyses of mortality. SETTING: Two large practices, an inner-city study practice, and a reference practice in a medium-sized town. METHOD: All premature deaths (aged one to 74 years) during 1994-1998 at the study practice (n = 170), and reference practice (n = 340), were identified. Cause-specific standardised mortality ratios (SMRs) were calculated using national reference data. The proportions of the total number of years of life lost (YLL) up to age 75 years associated with alcoholism, drug dependency, and severe mental illness were calculated and a comparison between practices was made, using standardised proportional mortality methods. RESULTS: Significantly raised SMRs for the study practice were lung cancer (SMR = 234), digestive system diseases (SMR = 362), and injuries and poisonings (SMR = 180). Having standardised for age, there were nearly four times as many YLLs in the study practice population associated with a history of alcoholism, and over three times as many associated with drug dependency, compared with the reference practice. CONCLUSION: Mortality analyses can provide useful insights for informing needs assessment in an individual practice. Small number problems may occur with smaller practice populations, but collation of data at PCG/T level also has potential utility. The study reinforces the argument that practices need to set up and maintain complete and accurate death registers.

Adolescent↗