Antimicrobial stewardship programmes were introduced in hospitals more than 30 years ago to address inappropriate antibiotic prescribing and increasing antibiotic resistance. Since then a large body of evidence on the effectiveness and safety of this approach has accumulated, and a new Cochrane Review updates the evidence on interventions and delivery methods to improve antibiotic prescribing.
Delivering health care at a distance is a practical and moral imperative in a world where underserved populations are the rule rather than the exception. Telemedicine epitomises the potential of technology to reshape health care delivery. But for interactive telemedicine – real-time distant interaction between a health professional and a patient – implementation has stalled.
Since the latter half of the 20th century, technological advances in modern medicine and a growing emphasis on preventive care have led to increased enthusiasm for screening in apparently healthy people. In primary care practice, the general health check (also termed periodic health evaluation or routine medical examination) is the usual mechanism used to screen asymptomatic people for disease. Although widely practiced, there is no universally accepted definition of what constitutes a general health check; screening may occur at variable frequencies and include a spectrum of diagnostic maneuvers ranging from physical examination to invasive procedures. Despite this variability, all general health checks share a common goal: to reduce morbidity and mortality by detecting disease or modifiable risk factors at an earlier stage—implicitly assuming that this will improve clinical outcomes compared with waiting until symptoms develop.
Innovative approaches aimed at reducing reliance on acute hospitals are being explored by providers of health systems around the world. These approaches reflect concern about the suitability of the hospital environment for people with complex healthcare problems who are often in need of some form of rehabilitation.
The idea that research evidence should play a more prominent role in health policy and health system management has been frequently promoted and widely accepted during the past decade. However, bridging the gap between what has been learned through research and what is considered salient by policy-makers and stakeholders is rarely straightforward.