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CLINICAL INDICATORS

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under 70 EMAs of Rose angina of CHD in. per 10, ... PREVALENCE OF GLASGOW PATIENTS WITH ANGINA ... EXPECTED ANGINA PREVALENCE BY PRACTICE, AGAINST DEPRIVATION ... – PowerPoint PPT presentation

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Title: CLINICAL INDICATORS


1
CLINICAL INDICATORS and QUALITY in
PRIMARY CARE
2
PRIMARY 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
3
THE MYSTERY OF PRIMARY CARE
4
PRIMARY 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)
9
STRIKING THE RIGHT LEVEL The clinical
encounter The practice The Community Health
Partnership NHS Scotland
10
4 KEY ELEMENTS OF PRIMARY CARE First
contact Continuity Comprehensiveness Co-ordinat
ion STARFIELD
11
PRIMARY 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
12
MAKING 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
13
KEY ELEMENTS Effective interventions
Population approach Long term
relationships
14
ILL-HEALTH VARIABLES BY DECILE
 
15
GP Resources by Deprivation Decile

 
16
GENERAL 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
17
DEPRIVATION, PSYCHOLOGICAL DISTRESS
AND CONSULTATION LENGTH IN GENERAL
PRACTICE Mark Stirling, Phil Wilson, Alex
McConnachie British Journal of General
Practice 200151456-60
18
ANALYSIS 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
19
GENERAL PRACTICE IN DEPRIVED AREAS
20
Voluntary activity in practices
PRACTICE ACCREDITATION
SPICE

TRAINING
PMS
 
British Medical Journal 20053311449-51
21
LOCATION 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

 
27
DEPRIVATION 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
28
GENERAL 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

39
Comparing OBSERVED with EXPECTED
40
MEASURING WHAT IS ..
NOT WHAT SHOULD BE
41
(No Transcript)
42
THE EFFECT OF USING PREVALENCE-BASED DENOMINATORS
ANGIOGRAPHIES PER CAPITA, 45-74
 
43
EXPECTED ANGINA PREVALENCE BY PRACTICE, AGAINST
DEPRIVATION
 
44
THE EFFECT OF USING PREVALENCE-BASED DENOMINATORS
ON FINDINGS
ANGIOGRAPHIES PER CAPITA, 45-74
ANGIOGRAPHIES PER EXPECTED CASE
 
45
CO-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

47
What do clinical indicators mean for The
clinical encounter ? The practice ? The
Community Health Partnership ? NHS Scotland ?
48
What can do done at the level of The clinical
encounter The practice The Community Health
Partnership NHS Scotland to improve clinical
indicators ?
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