Hospital-based doctors can make important contributions to improving population health through the application of public health principles to clinical practice in hospitals, according to a study published today in the British Journal of Hospital Medicine. The authors, public health doctors Dr. James McGowan from University of Cambridge, Dr. Helena Jopling from West Suffolk NHS Foundation Trust and Dr. Payal Patel from the University of Michigan, also argue that improving quality of care and advancing public health objectives are mutually reinforcing because healthcare remains a key determinant of health at a population level.

Hospital-based clinicians have often made transformational contributions to public health and quality of healthcare remains an important determinant of population health. By taking a ‘population perspective’ and  integrating public health principles into clinical practice, doctors should feel confident they can also make direct and valuable contributions to improving health at a population level, as well as improving the quality of care they provide for individual patients.”

– Dr James McGowan, NIHR Academic Clinical Fellow, The Healthcare Improvement Studies Institute

The paper reasons that to maximize their effectiveness in the delivery of healthcare, hospital doctors should increasingly take a population perspective to the practice of medicine. Emerging clinical and public health challenges such as antimicrobial resistance and multimorbidity already require frontline clinicians to rethink how they practice medicine; physicians will increasingly need to think in terms of prevention, stewardship of resources and addressing social determinants of health.

To operationalize the principles of public health into everyday clinical practice, the authors suggest some practical examples of public health approaches to tackling important clinical problems, including antimicrobial resistance, flu and invasive infections, non-communicable diseases, multimorbidity and polypharmacy.

 

Example behaviours to build public health principles into clinical practice   Practise narrow-spectrum prescribing and avoid prescribing antibiotics when not clinically indicated, e.g. for asymptomatic bacteriuria.   Prescribe flu vaccines for high risk patients and their families, and provide local leadership for vaccination campaigns.   Provide brief advice on health behaviours and take opportunities to refer patients to evidence-based prevention services, e.g. smoking cessation.   Deprescribe unnecessary medications where possible, particularly for patients on multiple medications.   McGowan et al 14 Nov 2018

 

Learn more

McGowan, J., Jopling, H., & Patel, P ‘The contribution of hospital doctors to public health‘. British Journal of Hospital Medicine, 14 Nov 2018

Dr James McGowan is a specialty registrar in public health medicine in the East of England deanery and a National Institute for Health Research Academic Clinical Fellow at the The Healthcare Improvement Studies Institute, University of Cambridge.

Media queries: Lucy Lloyd, Communications, Primary Care Unit

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