Coronary Heart Disease Prevention

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Coronary Heart Disease Prevention

• Hutton Rudby Surgery July 2000
• www.bradfordvts.co.uk

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Aims of This Presentation

• An overview of where we are now
• What we have achieved so far
• Introduction to the NSF
• How the NSF will affect us
• What do we have to do new or better

3
Where We Are Now

• We started to systematically care for patients
  with CHD in Feb 1997
• Created a register of patients with CHD
• Baseline audit in Feb 1997
• Follow-up audits in Sept 1998 and June 2000

4
Who Does What?

• Wendy Moore.
• Does initial checks as per ISIS.
• Explains to patient the importance of seeing the
  doctor afterwards.
• Updates records via the ISIS.

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Who Does What?

• Barbara Hodgson.
• Arrange monthly invites to patients.
• Log invitations on computer.

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Who Does What?

• Doctors various!
• Complete the checks started by Wendy.
• Update computer records.
• Opportunistically maintain register
• Audit.

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Register

• Restricted to patients with a past history of MI
  and or angina.
• The reminder CHD monitoring is used to identify
  the patients.
• Opportunistically updated.

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Register

• Monthly batches are invited by letter for a
  appointment with Wendy and asked to return to see
  a GP for completion of the check-up.
• Aims for annual check on all on the register.
• About seven patients per month.

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Audits

• 1997
• 74 patients on register
• 50 identifiably taking aspirin
• 55 had had cholesterol checked ever
• Average cholesterol 6.4mmol

• 2000
• 85 patients on register
• 86 identifiably taking aspirin
• 97 had had cholesterol checked ever
• Average cholesterol 5.2mmol

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Audits

• 2000
• Cholesterol - 79 checked in last year.
• Average BP 119/81
• 91 checked in last year.

• 1997
• Cholesterol - Only 33 checked in last year
• Average BP 153/86 -
• 83 checked in last year

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Introduction to the NSF

• National Service Framework
• A set of rules for whole NHS
• Maybe some stick attached

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National Service Framework

• By October 2000
• All practices to have teams that meet once a
  quarter to look at audits and discuss clinical
  issues.

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National Service Framework

• By April 2001
• Repeat medication records to be easily
  retrievable
• Systematically developed and maintained CHD
  register in place
• Use of register to provide structured care

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National Service Framework

• By April 2002.
• Protocols in place for assessment, treatment and
  follow-up of CHD patients.
• Protocols in place for the assessment, treatment
  and follow-up of people with heart failure.

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National Service Framework

• By April 2003
• Annual audit of CHD care
• Annual audit of Heart failure care

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How the NSF Will Affect Us

• Need too
• Create Heart failure register
• Produce Heart failure protocol
• Start auditing heart failure
• Systematically record exercise ECGs angiography

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What Do We Have to Do New or Better

• Systematically care for people with heart failure
• Automate the audits
• Discuss these issues regularly at practice
  meetings