Coronary Heart Disease Prevention

Hutton Rudby Surgery July 2000

Aims of This Presentation

An overview of where we are nowWhat we have achieved so farIntroduction to the NSFHow the NSF will affect usWhat do we have to do new or better

Where We Are Now

We started to systematically care for patients with CHD in Feb 1997Created a register of patients with CHDBaseline audit in Feb 1997Follow-up audits in Sept 1998 and June 2000

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 What?

Barbara Hodgson.

Arrange monthly invites to patients.Log invitations on computer.

Who Does What?

Doctors – various!

Complete the checks started by Wendy.Update computer records.Opportunistically maintain registerAudit.

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.

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 register50% identifiably taking aspirin55% had had cholesterol checked – everAverage cholesterol = 6.4mmol

2000

85 patients on register86% identifiably taking aspirin97% had had cholesterol checked – everAverage cholesterol = 5.2mmol

Audits

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.

Introduction to the NSF

National Service Framework

A set of rules for whole NHS

Maybe some stick attached

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 Framework

By April 2001Repeat medication records to be easily retrievable

Systematically developed and maintained CHD register in place

Use of register to provide structured care

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 Framework

By April 2003Annual audit of CHD care

Annual audit of Heart failure care

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

Systematically care for people with heart failureAutomate the auditsDiscuss these issues regularly at practice meetings