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Coronary Heart Disease Prevention. Hutton Rudby Surgery July 2000 www.bradfordvts.co.uk. Aims of This Presentation. An overview of where we are now What we have achieved so far Introduction to the NSF How the NSF will affect us What do we have to do new or better. Where We Are Now.

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coronary heart disease prevention

Coronary Heart Disease Prevention

Hutton Rudby Surgery July 2000

www.bradfordvts.co.uk

aims of this presentation
Aims of This Presentation
  • An overview of where we are now
  • What we have achieved so far
  • Introduction to the NSF
  • How the NSF will affect us
  • What do we have to do new or better
where we are now
Where We Are Now
  • We started to systematically care for patients with CHD in Feb 1997
  • Created a register of patients with CHD
  • Baseline audit in Feb 1997
  • Follow-up audits in Sept 1998 and June 2000
who does what
Who Does What?

Wendy Moore.

  • Does initial checks as per ISIS.
  • Explains to patient the importance of seeing the doctor afterwards.
  • Updates records via the ISIS.
who does what1
Who Does What?

Barbara Hodgson.

  • Arrange monthly invites to patients.
  • Log invitations on computer.
who does what2
Who Does What?

Doctors – various!

  • Complete the checks started by Wendy.
  • Update computer records.
  • Opportunistically maintain register
  • Audit.
register
Register
  • Restricted to patients with a past history of MI and or angina.
  • The reminder “CHD monitoring” is used to identify the patients.
  • Opportunistically updated.
register1
Register
  • Monthly batches are invited by letter for a appointment with Wendy and asked to return to see a GP for completion of the check-up.
  • Aims for annual check on all on the register.
  • About seven patients per month.
audits
1997

74 patients on register

50% identifiably taking aspirin

55% had had cholesterol checked – ever

Average cholesterol = 6.4mmol

2000

85 patients on register

86% identifiably taking aspirin

97% had had cholesterol checked – ever

Average cholesterol = 5.2mmol

Audits
audits1
1997

Cholesterol - Only 33% checked in last year

Average BP 153/86 -

83% checked in last year

2000

Cholesterol - 79% checked in last year.

Average BP 119/81 –

91% checked in last year.

Audits
introduction to the nsf
Introduction to the NSF

National Service Framework

  • A set of rules for whole NHS
  • Maybe some stick attached
national service framework
National Service Framework
  • By October 2000

All practices to have teams that meet once a quarter to look at audits and discuss clinical issues.

national service framework1
National Service Framework
  • By April 2001

Repeat medication records to be easily retrievable

Systematically developed and maintained CHD register in place

Use of register to provide structured care

national service framework2
National Service Framework
  • By April 2002.

Protocols in place for assessment, treatment and follow-up of CHD patients.

Protocols in place for the assessment, treatment and follow-up of people with heart failure.

national service framework3
National Service Framework
  • By April 2003

Annual audit of CHD care

Annual audit of Heart failure care

how the nsf will affect us
How the NSF Will Affect Us

Need too:

  • Create Heart failure register
  • Produce Heart failure protocol
  • Start auditing heart failure
  • Systematically record exercise ECGs & angiography
what do we have to do new or better
What Do We Have to Do New or Better
  • Systematically care for people with heart failure
  • Automate the audits
  • Discuss these issues regularly at practice meetings