Posted on February 6, 2018 by Niroshan Siriwardena

Comparing national multimorbidity policies and guidelines

People living with a long-term condition often have more than one condition to contend with. This is known as ‘multimorbidity’, commonly defined as the co-occurrence of two or more chronic conditions within one person. In this situation it is important that the person, not the disease, is the focus. Policies referring to multimorbidity are considered a crucial element in safe health systems.

The CaHRU team of Dr Nadeeka Chandraratne and Dr Ravindra Pathirathna, international visiting fellows attached to CaHRU from the Postgraduate Institute of Medicine at the University of Colombo, Sri Lanka, together with Prof Niro Siriwardena and Dr Christopher Harrison from the University of Sydney conducted a content analysis of policy documents and guidelines on multimorbidity from the UK, Australia and Sri Lanka. Despite considerable differences in healthcare structure and financing, all three countries face the challenge of multimorbidity. An understanding of how each country is addressing this challenge was considered important for identifying policy initiatives, gaps and opportunities for further improvement.

The article describing the study and its findings, ‘A comparison of policies and guidelines related to multimorbidity in the UK, Australia and Sri Lanka‘, was published this month in the first issue of the Australian Journal of General Practice 2018 with an accompanying editorial on Multimorbidity written by Niro Siriwardena and Christopher Harrison.

The team found overall a lack of health policy and guidance for multimorbidity: the guideline ‘Multimorbidity: Clinical assessment and management’ from The National Institute for Health and Care Excellence (NICE), UK was the only specific guideline on multimorbidity. Australia and Sri Lanka lack specific national documents addressing multimorbidity. The promising features observed in Australia were policies that are directly concerned with the health of socially disadvantaged groups, which are at higher risk of multimorbidity. Policies in Sri Lanka were more concerned with preventing chronic conditions, and on community mobilisation and empowerment.

The paper highlights that Sri Lanka needs to focus on policies that emphasise integration and patient-centred healthcare delivery for people with multimorbidity, whereas in the UK and Australia, policies on community-based approaches to address determinants of multimorbidity are needed.

By Dr. Nadeeka Chandraratne

Posted on October 11, 2014 by Niroshan Siriwardena

Sleep, health and wellbeing: NICE Topic Advisory Workshop

Professor Niro Siriwardena, director of CAHRU, attended a National Institute for Health and Care Excellence (NICE) topic advisory workshop on sleep, health and wellbeing. The event was hosted by NICE and chaired by Professor Colin Espie, Professor in the Nuffield Department of Clinical Neuroscience at the University of Oxford.

Attendees were invited experts on sleep and insomnia including sleep scientists, clinical respiratory specialists, public health experts interested in problems of insomnia at various ages from around the United Kingdom. Delegates contributed to discussions about the importance of sleep at various ages, the effects of insomnia on health and the public health implications of poor sleep. The main outcome of the meeting was agreement that sleep was an important public health issue and that NICE would consider developing a public health guideline for insomnia.

Professor Siriwardena and the CaHRU team have been working over the past few years on studies aimed at improving primary care for insomnia. This will be the topic of a conference at the Royal Society of Medicine, London, where experts from the UK and US will discuss ‘CBT for insomnia disorder: evidence base and practical implementation methods‘ on 19 November 2005.

Posted on August 10, 2014 by Niroshan Siriwardena

Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study

Researchers in CaHRU and East Midlands Ambulance Service NHS Trust (EMAS) have published a new study: “Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study” in BMC Emergency Medicine. The study’s lead author was Deborah Shaw of the Clinical Audit and Research Department at EMAS and visiting fellow at CaHRU. She was supported in the work by Prof Niro Siriwardena, director of CaHRU and associate clinical director at EMAS.

The authors aimed to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence, acknowledging variations in prehospital care for asthma. The investigators interviewed paramedics and managers and their analysis identified that guidelines should be made more relevant to ambulance service care; barriers to assessment; conflicts between clinicians’ and patients’ expectations; complex ambulance service processes and equipment; and opportunities for improved prehospital education, information, communication, support and care pathways for asthma.