Title: CLINICAL INDICATORS
1CLINICAL INDICATORS and QUALITY in
PRIMARY CARE
2PRIMARY CARE IS LED BY GENERAL PRACTITIONERS
General Practice Practitioners Nurses WTE
per 100,000 patients 70 24 Share of clinical
encounters 72 27 PTI data, 37
practices
3THE MYSTERY OF PRIMARY CARE
4PRIMARY CARE SECONDARY CARE Scattered Concen
trated Horizontal Vertical Self-employed Sal
aried Generalists Specialists
5 MAXIMUM ORGANISATIONAL QOF POINTS BY
DEPRIVATION DECILE IN SCOTLAND
6 MAXIMUM CLINICAL QOF POINTS BY DEPRIVATION
DECILE IN SCOTLAND
7 MAXIMUM CLINICAL QOF POINTS BY DEPRIVATION
DECILE IN SCOTLAND
8(No Transcript)
9STRIKING THE RIGHT LEVEL The clinical
encounter The practice The Community Health
Partnership NHS Scotland
104 KEY ELEMENTS OF PRIMARY CARE First
contact Continuity Comprehensiveness Co-ordinat
ion STARFIELD
11PRIMARY CARE MAKES A DIFFERENCE Does health
care improve health? Craig, Wright, Hanlon and
Galbraith Journal of Health Services Research and
Policy 2006111-2 Medicine matters after
all Bunker Nuffield Trust, 2001 Does health care
save lives? Avoidable mortality revisited Nolte
and McKee Nuffield Trust, 2004
12MAKING A DIFFERENCE IN PRIMARY CARE Reducing
severity symptomatic treatment Delaying
progression Mx long term conditions Reversing
risks BP, cholesterol, smoking Secondary
prevention cervical screening Primary
prevention diet, exercise Health protection -
immunisation
13KEY ELEMENTS Effective interventions
Population approach Long term
relationships
14ILL-HEALTH VARIABLES BY DECILE
15GP Resources by Deprivation Decile
16GENERAL PRACTICES IN SCOTLAND BY DECILE OF
DEPRIVATION Decile Population No of No of
GPs(WTE) practices 1
Affluent 535290 344 94 2 537391 378 112
3 534250 363 114 4 539389 364 95 5 5
29883 355 97 6 535521 355 108 7 536082
352 93 8 535599 339 105 9 538462 332
105 10 Deprived 528283 352 124 Briti
sh Medical Journal 20053311449-51
17DEPRIVATION, PSYCHOLOGICAL DISTRESS
AND CONSULTATION LENGTH IN GENERAL
PRACTICE Mark Stirling, Phil Wilson, Alex
McConnachie British Journal of General
Practice 200151456-60
18ANALYSIS OF 1000 CONSULTATIONS IN GENERAL
PRACTICE DEPRIVATION MEAN PREVALENCE CATEGORY
CONSULTATION OF POSITIVE TIME GHQ
(4) minutes 1 9.5 33 2 10.3
43 3 8.1 40 4 7.9 40 5 8.1 4
0 6 8.7 46 7 8.4 60
19GENERAL PRACTICE IN DEPRIVED AREAS
20Voluntary activity in practices
PRACTICE ACCREDITATION
SPICE
TRAINING
PMS
British Medical Journal 20053311449-51
21LOCATION OF THE MOST DEPRIVED PRACTICES IN
SCOTLAND HEALTH Decile 10 Decile 9 OF
ALL BOARD PRACTICES Greater
Glasgow 111 31 65 Lanarkshire 3 35 38 Ayrshi
re Arran 3 8 18 Argyll Clyde 4 12 16 Tay
side 5 6 15 Fife 1 6 12 Lothian 6 5 8
Forth Valley 0 3 5 Borders 0 0 0 Grampian
0 0 0 Dumfries and Galloway 0 0 0 Highland 0
0 0 Western Isles 0 0 0 Orkney 0 0 0 She
tland 0 0 0 TOTAL 133 106 100
22 23 24 25 26 27DEPRIVATION IN FOUR GENERAL PRACTICES PRACTICE QU
INTILE OF SOCIO-ECONOMIC DEPRIVATION Q1 Q2 Q3
Q4 Q5 1. 0.8 1.2 1.9 2.5 93.6 2. 22.6
18.4 20.3 19.8 18.8 3. 63.6 1.8 6.1 12.
4 16.0 4. 74.5 25.2 0.0 0.0 0.0 S
ource - SPICE
28GENERAL PRACTICES IN SCOTLAND BY DECILE OF
DEPRIVATION Decile Population No of No of
GPs(WTE) practices 1
Affluent 535290 344 94 2 537391 378 112
3 534250 363 114 4 539389 364 95 5 5
29883 355 97 6 535521 355 108 7 536082
352 93 8 535599 339 105 9 538462 332
105 10 Deprived 528283 352 124 Briti
sh Medical Journal 20053311449-51
29- CHD PREVALENCE IN PRACTICE POPULATIONS
- UNDER 70 IN NHS GREATER GLASGOW
- CHD EMAs Angina No of Population
- deaths practices
- 1 Most deprived 9.1 46.2 6.7 24 82,502
- 2 10.7 40.8 6.4 26 81.927
- 3 8.3 34.6 5.9 20 82,163
- 4 8.0 34.0 5.6 20 90,407
- 5 8.7 27.5 5.0 27 79,680
- 6 6.2 22.2 4.5 20 82,795
- 7 6.7 21.7 4.2 21 84,456
- 8 4.9 18.6 3.7 21 84,922
- 9 2.9 15.3 3.0 13 89,007
- Most affluent 2.7 14.8 2.8 17 81,941
- 101 Ratio 3.3 3.1 2.4
30- TRENDS IN STATIN PRESCRIBING IN PRACTICE
POPULATIONS - IN NHS GREATER GLASGOW BETWEEN 2001/2 AND 2004/5
- Dispensed daily doses (millions)
- 2001/2 2004/5 Increased
- 10 Most deprived 1.08 5.74 5.31
- 9 1.10 5.93 5.39
- 8 0.96 5.39 5.61
- 7 0.92 4.86 5.28
- 6 0.90 4.74 5.27
- 5 0.87 5.30 6.09
- 4 0.98 5.05 5.15
- 3 1.00 4.70 4.70
- 2 0.86 3.55 4.13
- 1 Most affluent 1.04 4.63 4.45
- 101 Ratio 1.04 1.24
31- TRENDS IN STATIN PRESCRIBING IN PRACTICE
POPULATIONS - IN NHS GREATER GLASGOW BETWEEN 2001/2 AND 2004/5
- Total prescriptions (millions)
- 2001/2 2004/5 Increased
- 10 Most deprived 0.024 0.07 2.91
- 9 0.025 0.07 2.80
- 8 0.020 0.06 3.00
- 7 0.018 0.06 3.33
- 6 0.017 0.05 2.94
- 5 0.018 0.06 3.33
- 4 0.018 0.06 3.33
- 3 0.019 0.05 2.63
- 2 0.017 0.04 2.35
- 1 Most affluent 0.018 0.05 2.77
- 101 Ratio 1.33 1.40
32- MEASURES OF CHD PREVALENCE IN PEOPLE UNDER 70
- Decile CHD deaths CHD Prevalence Prevalence
- under 70 EMAs of Rose angina of CHD in
- per 10,000 per 10,000 per 10,000 the QOF
- population population population (all ages)
- 1 3.3 13.8 255 312
- 2 4.6 23.0 287 356
- 4.5 20.5 298 359
- 4 5.1 24.6 298 359
- 5 6.3 24.9 345 385
- 6 5.4 29.7 340 404
- 7 6.8 30.4 387 406
- 8 7.6 34.0 399 414
- 9 7.9 35.4 427 419
- 10 8.9 38.3 570 423
- 10/1 2.7 2.8 2.2 1.4
33- PREVALENCE OF GLASGOW PATIENTS WITH ANGINA
- BY AGE WITHIN QUINTILES OF SOCIO-ECONOMIC
DEPRIVATION - Quintile Age
- lt60 60-69 70-79 80-89
- Least deprived 13 26 38 23
-
- 18 28 35 19
- 3. 19 28 35 18
- 4. 22 31 33 14
- Most deprived 23 29 33 15
- Row percentages
34- DISTRIBUTION OF GLASGOW PATIENTS WITH ANGINA
- BY QUINTILES OF DEPRIVATION WITHIN 10 YEAR AGE
GROUPS - Quintile Age
- lt60 60-69 70-79 80-89
- Least deprived 11 15 18 21
- 2. 15 16 17 19
- 3. 20 20 21 22
- 4. 25 23 20 17
- Most deprived 29 26 24 21
- Column percentages
35- PREVALENCE OF GLASGOW PATIENTS SURVIVING MI
- BY AGE WITHIN QUINTILES OF SOCIO-ECONOMIC
DEPRIVATION - Quintile Age
- lt60 60-69 70-79 80-89
- Least deprived 14 26 36 24
-
- 21 27 33 18
- 3. 22 26 33 18
- 4. 25 28 32 15
- Most deprived 22 27 34 16
36- DISTRIBUTION OF GLASGOW PATIENTS SURVIVING MI
- BY QUINTILES OF DEPRIVATION WITHIN 10 YEAR AGE
GROUPS - Quintile Age
- lt60 60-69 70-79 80-89
- Least deprived 11 16 18 22
- 2. 18 18 18 19
- 3. 22 21 21 22
- 4. 24 21 20 17
- Most deprived 24 23 23 20
- Column percentages
37- PREVALENCE OF GLASGOW PATIENTS WITH HEART FAILURE
- BY AGE WITHIN QUINTILES OF SOCIO-ECONOMIC
DEPRIVATION - Quintile Age
- lt60 60-69 70-79 80-89
- Least deprived 7 20 37 26
- 2. 12 24 38 26
- 3. 13 23 37 26
- 4. 15 25 38 21
- Most deprived 14 25 39 22
38- DISTRIBUTION OF GLASGOW PATIENTS WITH HEART
FAILURE - BY QUINTILES OF DEPRIVATION WITHIN 10 YEAR AGE
GROUPS - Quintile Age
- lt60 60-69 70-79 80-89
- Least deprived 8 12 14 20
- 2. 16 17 17 17
- 3. 22 21 21 22
- 4. 26 23 22 18
- Most deprived 29 27 26 22
- Column percentages
39Comparing OBSERVED with EXPECTED
40MEASURING WHAT IS ..
NOT WHAT SHOULD BE
41(No Transcript)
42THE EFFECT OF USING PREVALENCE-BASED DENOMINATORS
ANGIOGRAPHIES PER CAPITA, 45-74
43EXPECTED ANGINA PREVALENCE BY PRACTICE, AGAINST
DEPRIVATION
44THE EFFECT OF USING PREVALENCE-BASED DENOMINATORS
ON FINDINGS
ANGIOGRAPHIES PER CAPITA, 45-74
ANGIOGRAPHIES PER EXPECTED CASE
45CO-MORBIDITY The number, severity and
complexity of health and social problems within
families
46- CONCENTRATIONS OF
- Problems within families
- Families within practices
- Practices within areas
47What do clinical indicators mean for The
clinical encounter ? The practice ? The
Community Health Partnership ? NHS Scotland ?
48What can do done at the level of The clinical
encounter The practice The Community Health
Partnership NHS Scotland to improve clinical
indicators ?