Quality Goals for April 06

1
Quality Goals for April 06

• Consolidate Quality by Improving
• 1049-1050 Points for all practices
• Screening for the 10 chronic conditions
• Diagnosis register accuracy
• Clinical Reviews
• Outcome Measures
• Patient Involvement

2
Chronic Disease Prevalence
3
Five Hypertension Indicators
4
Prevalence by Age and Sex
5
Hypertension Prevalence

• UK Community surveys quote prevalence
• Patients gt 16 37
• Patients gt 65 81
• GP Practice prevalence is much lower
• Patients gt 16 14.4
• Patients gt 65 - 46

6
How to Screen for Hypertension

• Opportunistic screening in primary care is ideal
• 70 of pts consult annually 90 in 5 years
• Patients never refuse a BP check
• Screening only takes 1-2 mins per quinqennium
• GP workload about 11 mins a week or 9 hrs a year
• Most efficient screening programme on earth
• Achieving uptake of 80-90 is straightforward

7
Potential Hypertensives

• 492 patients whose last recorded BP was gt140/85,
  but where unsuccessful recall has not allowed a
  diagnosis of hypertension to be confirmed or
  refuted
• About half are likely to have hypertension.

8
Accuracy of BP Measurement

• BP is bobbing up down all day long
• Single measurement is unreliable
• Patient should be seated, relaxed with arm
  supported
• Correct Cuff at heart level
• Calibrated Sphygmomanometer
• Automatic or Aneroid ?

9
Medical students can cause blood pressure to
rise, report says

• A new study has shown that the presence of a
  medical student can increase BP when measured in
  general practice
• The researchers found that BP was significantly
  higher when a medical student or trainee was
  present during consultations

10
BP Measurement Bias
11
Does Terminal Zero Bias Matter

• NO if readings well within target range
• YES if at threshold for diagnosing hypertension
• YES if at threshold for increasing medication

12
Confirmation of Diagnosis

• Sustained readings over 140/90
• BP sky high with TOD. Diagnosis straightforward.
  Proceed to Treatment
• Remainder carefully confirm by
• 2 surgery readings - 4 different consultations
• HBPM Automatic upper arm home BPs over several
  days
• ABPM 24 hour record

13
Validity of Registers
14
Diabetes and HypertensionApril 2005 SDN Practice

• 15.3 of hypertensives have diabetes
• 24 of Type 1 diabetics have hypertension
• 53 of Type 2 diabetics have hypertension

15
Beta Blockers and Thiazides

• Recent modification to ABCD code
• B D increases diabetes incidence 0.4 per year
• B D is not ideal for hypertensives with
• BMIs over 30
• Family history of diabetes
• History of gestational diabetes or IGT
• South Asian Afro-Caribbean patients

16
Hypertension - Target BPs

• Clinical control target 140/85 (BHS 4)
• Audit standard for QOF is 150/90
• Clinical Target Diabetes 130/80 (BHS 4)
• Audit standard for QOF is 145/85 (BHS 3)
• Renal damage clinical target is 130/80

17
Obstacles to Good BP control

• Confusion over guidelines
• Doctor Nurse inertia
• Reliable BP measurement
• Prescribing unacceptable therapies with side
  effects
• Concordance - Getting message to patient
• Poor Follow Up

18
BP Suggestions for 2005-06

• Improve Screening Levels
• Follow up Potentials for Accurate Diagnosis
• Improve Practice Nurse Training
• Calibrate BP machines
• Audit of Drug Prescribing use more agents
  more combinations
• Relentlessly target raised diabetic BPs lt 130/80
• Review hypertensives on B D. Change therapy of
  those at high risk of developing diabetes.
• Surgical Referrals Raised BP common cause of
  delay in operations. Sort hypertension first

19
Value of Care Plans e.g. Diabetes

• Educational tool for patient
• Spells out why good control of BP, Cholesterol
  glycaemia is essential
• Empowers patients to take more responsibility
  for their own diabetes management.
• Annual monitoring tool for practice

20
Personalised Diabetic Care Plans
21
Improve Quality Reviews with hot keys

• Example - Asthma Annual Review
• Step One/Two/Three
• Current, predicted and best ever peak flow
• Symptoms B2A doses for Wheeze per week EIA ,
  nocturnal cough
• Inhaler and spacer technique
• Management plan 05 06

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06 07 Targets - Obesity