Annex
THREE EXAMPLES OF PRIMARY CARE BASED PUBLIC
HEALTH
EXAMPLE 1: A NEW
LUNG CANCER
IS DIAGNOSED
A 62 year old man presents with cough and blood
stained sputum. The general practitioner requests a chest X-ray
which shows a large, inoperable cancer of the bronchus. The GP
sees the man with the result and arranges an urgent referral.
At a significant event discussion this case is discussed. There
is no record in the notes (paper or computer) of the man's smoking—he
smokes 30 cigarettes per day—but he had been invited twice
to a well person check. The practice considers what help it might
have offered this patient and agrees that its smoking cessation
support is fragmented. One nurse agrees to look into best practice.
She returns with information that leads to a special clinic for
smoking cessation with access to a hypnotherapist. A special smoking
campaign for teenagers is designed and implemented. The recording
of smoking habits is given a high priority and over the next year
improves greatly.
EXAMPLE 2: AN
ACUTE ADMISSION
FOR ASTHMA
A young man is admitted with an acute, severe
asthmatic attack and survives, but only after cardio-pulmonary
resuscitation. The practice discusses the case and decides that
the acute care was efficient and effective. However, it becomes
clear that the man had not been using his inhalers regularly,
was an episodic smoker and lived in a damp house provided by the
local housing association. The patient had not been reviewed recently
by a doctor or nurse and there is no record of smoking advice
or support being given. There is a long discussion of the possible
contribution made to this by the man's poor English. The practice
decides to do three things: one nurse and one general practitioner
are to set up an asthma service, which will include special advice
and support for smokers. A regular audit will look at the outcomes
of this service and a patient survey will be used to determine
the best time to hold asthma clinics. The practice also decides
to hold discussions with the housing association. They readily
admit that their houses are damp and may contribute to ill health.
An investment programme to upgrade the houses is discussed and
implemented over a two-year period. The last action is to hold
discussions with community leaders and the health authority to
develop an effective interpretation service for those patients
with poor or non-existent English. This led to an interpretation
service using community volunteers.
EXAMPLE 3: A CHILD
IS KILLED
BY A
CAR
Following the death of a toddler on a "quiet"
back street, the practice decides to campaign for traffic calming.
In doing so it recognises that it cannot prevent another death
or injury by clinical care, only through social action. In discussions
with the local authority and the health authority, agreement is
reached on making one road a "no through" area, and
placing traffic humps on one other street. At the suggestion of
the health authority, the practice agrees to take part in a campaign
to increase the installation of smoke alarms by placing posters
in the waiting room, and including smoke alarms in discussions
at child checks, ante-natal clinics, well person checks and visits
to the elderly. The Primary Care Group invites all the other local
practices to joint in this campaign.
REFERENCES
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