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Title: What are primary care and secondary care practitioners doing with respect to Cardiovascular risk Assessment
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PHW Staff Conference 2011 • Title: What are primary care and secondary care practitioners doing with respect to Cardiovascular risk Assessment • This presentation will show the results of a questionnaire to primary and secondary care clinicians which aimed to find out what services were being provided in respect to CVD risk assessment. It will also highlight a method of data extraction from primary care to assess the completeness of data required for CVD assessments in primary care. It will explore the options for CVD risk assessment service and highlight the requirements of this service.
What are primary care and secondary care practitioners doing with respect to Cardiovascular risk Assessment Primary Care Quality and Information Service (PCQIS) 11th October 2011– PHW Staff Conference Pharmaceutical Therapeutic Interventions Group Paul Myres, PCQIS Clinical Lead
CVD Project Key Deliverables • Mapping of relevant existing services in primary care, secondary care and the community (30th June 2011) • Recommendations for the implementation of a systematic and co-ordinated CVD risk management programme (31st October 2011) Susan Mably, Project Lead
Primary/ Secondary Care • Extent, location and consistency of relevant services/practices • Extent of current use of risk tools/ other approaches • Routine data and ICT available - completeness and usefulness of data • QOF Registers • Avoid duplication of effort/ provision Susan Mably, Project Lead
Methodology and response rate PHW Staff Conference 2011 • A questionnaire was emailed to every general medical practice in Wales • There are currently 496 general medical practices in Wales. • 33% of practices responded (n=165). Practices responded from all 7 Health Boards and all 22 localities. In cases where more than one GP from the practice responded the findings were amalgamated so that only 1 response per practice was included.
Secondary Questionnaire (poor response rate) PHW Staff Conference 2011
Audit+ Software PHW Staff Conference 2011 • The two pilot practices data included may not be representative of general practice as a whole. • This data is presented here to demonstrate the functionality and usefulness of Audit+, it shows us the extensive data we can obtain regarding risk factors and interventions in the practice registered population of Wales. • It is also extremely useful for individual practices to assess how well they are doing with regard to CVD risk assessment and may show areas where they need to focus their efforts to improve equity and effectiveness • The two pilot practices have given consent in making this data available but the practice list size is approximated to provide anonymity (ie either rounded up or rounded down).
Established clinical cardiovascular disease or high likelihood PHW Staff Conference 2011
Audit+ data (2 pilot practices) PHW Staff Conference 2011
Established CVD modifiable risk factors PHW Staff Conference 2011
Established CVD modifiable risk factors PHW Staff Conference 2011
Chronic Kidney Disease modifiable risk factors PHW Staff Conference 2011
Chronic Kidney Disease modifiable risk factors PHW Staff Conference 2011
Hypertension treated to target BP PHW Staff Conference 2011
Which patients receive risk assessment? PHW Staff Conference 2011 • The questionnaire data show that 86% of practices offer risk assessment to all patients with a recognised risk factor and 21% of practices offer risk assessment to all patients of a certain age, the majority offering it to all those aged over 40. • Over half of nephrologists and one third of cardiologists who responded risk assess (using a risk tool or informally) all patients who attend their clinic. No patients receive a CVD risk assessment from the rheumatologists who have responded.
Cholesterol testing: PHW Staff Conference 2011 • Audit+ pilot data shows that high percentages of patients with diabetes, stroke/TIA, CKD, rheumatoid disorders, hypertension and/or BMI >30 have had cholesterol tests recorded in the past 2 or 5 years (as recommended by the appropriate guidelines). • Some testing is undertaken in secondary care – risk of duplication.
Smoking cessation support: PHW Staff Conference 2011 • 68% of responding practices said their practice staff provide smoking cessation services and 77% said they refer to external smoking cessation services. • Audit+ data shows high percentages of smokers >40 recorded as having been offered smoking cessation advice but low percentages of smokers recorded as being referred to a formal ‘in house’ stop smoking clinic and no patients having been referred to an outside stop smoking clinic (this may be a recording issue).
What might help? PHW Staff Conference 2011 • General Practice records as the prime repository of risk factor data • A nationally recommended risk tool • A standardised agreed process for risk assessment and risk management • Risk assessments undertaken in primary care (this may be undertaken in general practice or by pharmacies but there must be sharing of data) • Audit+ data used to assess the effectiveness of the programme and used to provide real-time feedback to practices to help them identify where they need to focus their efforts • Practices provided with standard software which supports agreed risk assessment in practices and support practitioners explain risk to patients and the benefits or otherwise of interventions to reduce risk
