Healthy Heart Clinics

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Healthy Heart Clinics

• Dr Mike Civil, GP
• Wendy Smith, Practice Nurse

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Introduction

• Stirk Medical Group has two locations, a branch
  and a main surgery
• There are 10 doctors working at Stirk, 6 Nurses,
  8 Reception Staff and a Practice Manager
• It is a paperless practice, using PractiX
  (Plexus) software
• The two surgeries are connected by a Broadband
  connection and Patient Files may be accessed at
  either surgery, for any patient of the practice

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Personnel Involved with Clinics

• Dr Mike Civil, Medical Director at Stirk Medical
  Group, contact GP with the NPCC-Collaboratives
  Program
• Wendy Smith, Practice Nurse, primary focus
  Chronic Disease Management Clinics
• Other GPs involved at the practice, one doctor
  particularly involved with the Chronic Disease
  Clinics
• Practice Manager
• Other Practice Nursing Staff

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NPCC-Collaboratives Program

• A Collaborative is
• An improvement method that relies on spread and
  adaptation of existing knowledge to multiple
  settings to accomplish a common aim

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Collaborative Topics

• The NPCC program has focused on the following
  areas
• Secondary prevention of CHD
• Care of people with diabetes
• Better patient access to primary care services
• Key methodology being used to achieve aims is the
  PDSA (Plan Do Study Act) Cycle

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PDSA Cycle

• Objective
• Define the problem
• What are you trying to achieve?
• Plan
• Who, what, where, when?
• Measurement
•  Do
• Just do it!
• Study
• What worked? What didnt?
• Act
• Next steps

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Secondary Prevention ofCoronary Heart Disease

• Collaborative aim
• A reduction in the mortality of patients with
  CHD by 30 in three years and 50 in five years
  in participating sites

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CHD Measures

• The NPCC Collaboratives Program looks at the
  following areas, (as has been decided by the
  Expert Panel)
• Number of CHD patients on register
• CHD patients on aspirin
• CHD patients who are on a statin
• patients who have had a MI in past 12 months
  who are on beta-blockers
• CHD patients whose last recorded BP within last
  12 months lt140/90

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CHD Change Principles

• Establish a system for creating, validating
  updating a register
• Be systematic pro-active in managing care
• Ensure timely high quality support from
  secondary care
• Involve patients in delivering developing care
• Build effective links with other key local
  partners

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Nurse Lead Clinics

• Nurses are able to devote greater periods of time
  to the running of Chronic Disease Clinics
• Doctor involvement can be reduced, enabling
  chronic disease management to be performed
  efficiently and to not increase the work burden
  of the doctors
• Increase job satisfaction and interest for Nurses
  working at the practice
• With doctor work force issues, there is a need
  for lateral thought and ideas, to address patient
  care
• With the billing incentives at Medicare, there is
  facility for most practices to either expand
  their use of Practice Nurses, or to employ a
  Practice Nurse

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Diabetic Patient Clinics

• Diabetic Clinics were set up following practice
  participation in the Collaborative Program
• Ideas were gained by attending Workshops and
  discussing issues with other practices
• Meetings held at practice with Nursing Staff and
  Doctors
• Identifying patients with Diabetes, clarifying
  the Diabetic Register
• Coding of Chronic Disease in Patient Files
• Giving Ownership of the Clinics to the Practice
  Nurse
• Recall of patients to the Clinic, time
  allocations, financial implications and Chronic
  Disease condition billing, 721, 724, etc

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Coding patient Conditions

• Chronic Disease Registers
• Using Coding to form the basis of all Chronic
  Disease Registers
• Patients coded as being Diabetic, or having Heart
  Disease, etc, would form the basis of the Disease
  Register
• How to code patient files?
• What system to use with coding. Existing coding
  or Chronic Disease identification (Free Text or
  Formalized coding system)
• PractiX uses ICPC coding
• Aim is to code every consultation

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Coding Issues

• Encourage doctors to enter coding every time
• Prompts within the Software System
• Sticky label prompts
• Extraction Tools within the Software package
• Extraction Tools external to the software package

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Issues with regard to the Healthy Heart Clinics

• Aims of the clinic, what do we want to achieve?
• How do we identify patients who would benefit
  from the clinic?
• How do we notify patients of the existence of the
  clinic?
• Financial issues for the practice and the patient
• Structure of the Clinic, doctor involvement or
  not?
• Skills of the nurse running the clinic ? Need to
  upskill or further educate, doctors and nursing
  staff involved with clinics
• Presentations from outside Specialists
• Feedback, regarding the Collaboratives program
  and benefits to be had with the management of
  Chronic Disease management

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Aims of the Clinic

• Improve the management of Cardiovascular Risk
  patients
• Identify patients who were not previously known
  to have a higher Cardiovascular risk profile
• Optimize management and treatment of these
  patients
• Improve lifestyle factors with these patients

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Identifying Patients

• Using the extraction tools to identify patients
  that are on certain medication, ie the Medication
  criteria of the Collaboratives program
• Includes Aspirin based compounds, Beta Blockers
  and Cholesterol lowering drugs
• Hand out leaflets when patients arrive at the
  front desk
• Advertising the existence of the clinics in the
  Practice News Letter
• Advertising the existence of the clinics on Flat
  Screen display in the waiting room
• Opportunistically, letting doctors and nurses
  know that the clinics are going to be held,
  involve all team members

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Patient Handout

• Patient Handout for the clinics, emphasizes
  Cardiovascular issues, in Questionnaire Format
• Whilst patient wait to see doctor, complete
  questionnaire and then mark themselves (or
  discuss with their GP) and assess whether there
  is a need to consider the clinic
• Points system on Questionnaire
• Patients can choose to not discuss with the GP
  and to just make an appointment for the Clinic
  independently

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Financial Issues with running the Clinics

• Clinics do not currently attract the GPMP item
  numbers
• ? Eligible for the new Screening Medicare Item
  numbers, MBS item numbers 717 and 710 (for
  Aboriginal and Torres Strait Islanders) 45-49 yr
  old health checks
• Patients need to be seen by GP, however briefly
  to attract Rebateble fee.
• Clinics advertised to patients as a Free Service
• If a patient is recognized as being a
  Cardiovascular risk, then the patient can be
  offered an ECG. Primarily as background
  information
• Fees 23 or 36 depending on the consultation with
  the GP 11700 for an ECG, or item 717 with ECG
  as well

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Structure of the Clinics

• Patients booked at 20 minutes with the nurse and
  a standard appointment with their GP
• Questionnaire gone through with the patient and
  Nurse
• Measurement of Height / Weight. BMI calculation
• BP measurement
• Smoking History
• Family History of Cardiovascular disease
• Other co Morbidity, such as Diabetes
• Exercise and other life style issues
• Current Medication and Strategies
• Plans for Future lifestyle issues
• Alcohol intake / consumption

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Analysis of the Effectiveness of the Clinics

• Informally, via patient feedback to doctors and
  nursing staff
• Survey patients with regard to observing their
  degree of satisfaction
• Review of the Collaborative Program measures, the
  make up of the Cardiovascular Disease Register
  will change as a result of the Clinics
• Monthly data for the Collaborative Program will
  change and the percentage of patients who should
  be on certain medication will also alter

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Alternative Chronic Disease Clinics

• Diabetes
• Chronic Heart Disease and Cardiovascular Risk
• Asthma
• Osteoporosis
• Smoking
• Lifestyle, exercise
• Sexual Health, womens health

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Resources

• Collaborative program resources
• http//www.npcc.com.au/W2_LW2_Presentation/Plenary
  _CHD_AT.pdf
• http//www.npcc.com.au/W2_LW1_Presentations/Plenar
  y_CHD_ST.pdf
• http//www.npcc.com.au/index.html

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Questions