TINTENBAR MEDICAL CENTRE

1. TINTENBAR MEDICAL CENTRE FRONT SLIDE FRONT SLIDE

2. IHD Establish a system for creating, validating and updating a register of people with IHD Be systematic and proactive in managing care Involve patients in delivering and developing care Develop links with key local partners Analyse your secondary care interface Later “Building the practice team”

3. IHD Clean up of IHD register Search database for various diagnoses relating to IHD All staff to review list re deaths, left area etc Search database for patients not attended in past 2 years These patients contacted by nurse to check still our patients Search for anti-anginal medications found 2 more Compare list from NPCC data extraction with our list Encourage other docs to enter diagnosis Staff to enter highlighted diagnosis from discharge letters Develop protocol to maintain register DOCUMENT ALL THE STEPS FOR NEXT YEAR

4. Establish a system for creating, validating and updating a register of people with IHD Be systematic and proactive in managing care Involve patients in delivering and developing care Develop links with key local partners Analyse your secondary care interface Later “Building the practice team”

5. Measures for IHD ASPIRIN: enter reminder in action list on Med.Dir. Review notes of patients not on aspirin, 30% on either clopidogrel or warfarin or Aspirin contra-indicated. Sticky note in other patients notes. Repeat audit BLOOD PRESSURE: enter bp on computer, educating GP’s re targets, reminder in action list, review notes of IHD patients who attended over one month and review % with bp entered CHOLESTEROL: education re targets, review patients not on statins, sticky note in patients’ file.

6. WHAT ELSE? Needed to be simple and evidence based. Use collaborative principles of stealing shamelessly. Based on Heart Foundation guidelines.

7. WHAT DID I FIND? PSYLLIUM HUSK: 5g bd to lower cholesterol. eg. Trial showed mean lowering of LDL in group receivingsimvastatin10mg plus psyllium was the same as that in group on simvastatin 20mg plus placebo.1

8. EXERCISE AND WEIGHT LOSS Weight loss can lower systolic bp by on average 2mm Hg per 1kg of weight loss ie 10kg weight loss drops bp by 20mmHG1 “If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation”.23 Regular aerobic exercise can lower systolic and diastolic bp by on average approx 4 and 2.5mmHg respectively, There is incontrovertible evidence that regular physical activity contributes 1’ and 2’ prevention of CVD.4

9. ALCOHOL, DIET AND CARDIAC REHAB 2 standard drinks per day for men, 1 for women, is beneficial for heart disease Increase fish in diet, 5 serves of fresh fruit and veg per day and more grains and pulses Omega 3 fatty acids Psyllium husk? Cardiac rehab programme Early call to 000. Patient-held records

10. DEPRESSION Up to 1 in 4 of IHD patients suffer with depression “A brisk 30 minute walk 3 times per week may be just as effective in relieving major depression as are standard antidepressants.”1

11. WILL IT WORK? International review “brief interventions combined with written material lead to modest increases in physical activity in the short term and 6 months.” Action Plans “ 53% of patients making an action plan reported making a behavior change consistent with that action plan.”

12. HOW TO DO IT? 10 000 Step programme. www.10000steps.org.au

13. RED BOOK Shared care “Red Book” Recommended targets Personalised targets CPR info Health summary Immunisation record Use of nitrate for chest pain advice Space for recording bp,wt,cholesterol comments Information leaflets 10 000 step advice Info re exercise groups, and alcohol

14. Establish a system for creating, validating and updating a register of people with IHD Be systematic and proactive in managing care Involve patients in delivering and developing care Develop links with key local partners Analyse your secondary care interface Later “Building the practice team”

15. IHD CLINIC Identify patients who had not been seen recently Phoned by nurse Questionnaire whilst waiting to be seen Interview with nurse for 45 min using set format and preparation of GP Management plan +/- TCA 15 min with GP Offered review by nurse at 6 weeks GP review 6 months New GP Management Plan in 2 years

17. SO HOW DID IT GO? 100% Uptake Positive feedback Most wanted to review progress with nurse in 6 wks Low cost, used available resources Income from GPMP and BB nurse review Fiddly to arrange appts Patients with other requests at clinic Difficult to maintain

18. 9 MONTH REVIEW 80% uptake of 6 Month review

19. Establish a system for creating, validating and updating a register of people with IHD Be systematic and proactive in managing care Involve patients in delivering and developing care Develop links with key local partners Analyze your secondary care interface Later “Building the practice team”

20. WHAT ELSE? Local walking group, “Just Walk It” Change menu at local store Develop a local support network for isolated people in local community Improved health and fitness in staff at surgery, Boot Camp Talk to council about footpaths and cycle ways Annual Heart Disease week at surgery Annual in-service re CPR Increased nurse hours Surgery extension to create “chronic care nurse room” Form a calendar focusing on chronic conditions Quit programme Click for aminationClick for amination

22. Establish a system for creating, validating and updating a register of people with IHD Be systematic and proactive in managing care Involve patients in delivering and developing care Develop links with key local partners Analyse your secondary care interface Later “Building the practice team”

23. TEAM BUILDING Whole of practice meetings Communication Encourage all staff to contribute PDSA’s 10,000 step challenge Art exhibition Boot camp

24. DIFFICULTIES Gap between what we know and what we do, change the system and close the gap Maintain registers/database/clinics Make everyone feel involved Overcome scepticism Finding time Space Keep staff engaged How to improve figures How to keep in touch How to share ideas

25. WHAT DID WE LEARN? To work as a team To measure what we do To embrace change To look at systems To review roles of our staff To share and steal ideas from other practices To celebrate what we do well To identify what we do not do so well