Primary Care Intelligence

1. Primary Care Intelligence A GP Perspective with a COPD focus Dr Noel Baxter, Surrey Docks Health Centre & London Respiratory Team

2. COPD in London: what do we know? 7,619,800 Londoners Mid-2008 population estimate How many are living with COPD?

3. 24 Recommendations included in Operating Framework Dec 2010

4. Right Care Priorities • Stop smoking support and therapy as treatment for COPD • Pulmonary Rehabilitation • Responsible Respiratory Prescribing • Responsible Oxygen Prescribing

5. Using APHO Profiles in COPD COPD in Primary Care… A slow awakening Getting motivated Changing attitudes Less interest in LOS/Admissions

6. Using APHO Profiles What works well… Adds value to QOF data Compare practices using local knowledge Visually useful for overall picture

7. Using APHO Profiles What needs to be reviewed… QOF too easily achieved Not enough reds and greens Looks like everyone the same

8. COPD 13: A review including MRC score Not required for QOF

9. COPD 10 &12: FEV1 at diagnosis and every 15 months Not required for QOF Not required for QOF

10. Evidence based therapy Not required for QOF Not required for QOF

11. Interpreting APHO Profiles

12. www.audit-commission.gov.uk 09/10Exception rate (%)   No of exceptions CVD primary prevention            18.97                          119,103 Heart failure                                17.23                            93,808 COPD 12.65                         348,939 Mental health                              10.80                         102,104 Epilepsy                                       7.82                           77,80

13. Exception reporting in COPD Nihilism in both parties Housebound – Silo working Confusion around diagnostic criteria Is it a marker for quality of care?

14. Exception reporting review All years: 13 patients exception reported without valid justification 8: Conflict about diagnosis 1: Patient too frail 4: No clear justification

15. Interpreting APHO Profiles Achieved QOF for ‘ inappropriate’ exception reported patients

16. COPD measures in primary care (Wish list) • Prevalence of smokers in COPD register • Offer and provision of effective stop smoking treatment • Prescribing data • Measuring outcomes • Completion of pulmonary rehabilitation • Quit smoking at 1 year • PROM • Hypoxia Assessed • CO Measured • Stratification using MRC scores

17. Stopping smoking works… Fletcher, Peto: Br Med J 1977; 1 :

18. Long-term effectiveness and costeffectiveness of smoking cessation interventions in patients with COPD Tiotropium QALY £7,112 Eur J Health Econ. 2007; 8(2): 123135 Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mo¨lken MPMH Thorax 2010: 65:711-718

19. Explaining Variance and aligning data

20. Explaining Variance and aligning data

21. Explaining Variance Current Smokers

22. Explaining Variance Never Smoked

23. What do we know:Smoking prevalence in ‘COPD’? At best one in four Londoners with COPD are still smokers….

24. 2009-2010 Smoking history distribution of a GP COPD List (n=111)

25. 2009-2010 Smoking history distribution of a Tiotropium treated COPD List (n=52)

26. League Table Anxiety Performance - LMC Being open and supportive Motivating presentation of data Shifting resources Using revalidation

27. Consortia need help to measureprimary care outcomes in COPD Annual prevalence of current smoking in COPD register % offered evidence based Stop smoking therapy % MRC 3 who were referred / completed PR % MRC score 3 or more with Pulsoximetry result Patient satisfaction of COPD care Consortia costs/per practice costs Admissions per practice