Challenges to Primary Care

1
Challenges to Primary Care

• Irene McGonnigle
• Heart Failure Nurse Specialist
• 28th February 2006

2
Overview

• Chronic disease management
• Heart failure management
• Registers and read codes
• GMS
• Partnership working
• Improved patient care

3
Chronic disease management

• More than 17.5 million people report living with
  a long term condition
• Many experience reactive, unplanned and often
  acute based responses to deterioration
• Need to provide pro-active, planned, patient
  centred care based in primary care

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Chronic disease management

• We need
• Excellent communication and partnership working
  across the whole health and social care spectrum
• Effective, systematic approaches to heart
  failure management in primary care
• Utilise tools and techniques already available

5
Heart failure management

• 50 of HF patients in Europe are not receiving
  optimal treatment
• 75 of PC GPs rely solely on signs and symptoms
  to diagnose HF
• Just over 50 pts are on ACE and 34 BBs
• Survival rates from HF are worse than for most
  cancers
• SHAPE study (2003) www.heartfailure-europe.com

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HF Management

• Practice based
• Agree management process protocols, read
  codes, etc
• . LHCC/CHP
• Support, Formulary drugs, ?BNP

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HF Management Practice based

• Protocols to allow
• Prompt consideration of HF diagnosis
• Instigate appropriate investigations
• Results to be coded appropriately and
  consistently
• Inform treatment/management plan
• Confidence in HF management

8
Registers

• GMS requires register of patients with CHD and
  LVD
• Other HF sub groups not included in this
  register
• Potentially patients not identified and therefore
  being missed
• Need to validate and update existing registers
  to identify all patients with HF

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Registers

• Build on existing registers to identify missed
  patients/confirm or discard others by
• Retrospective Id of patients via
• Drug searches
• Computer read codes
• Echo and angio results (and others)
• Agree codes to be used in register

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SCIMP Read Codes

• Include
• LVDD G5yyA LVF G581.
• Cardiac failure G58..
• Ischaemic cardiomyopathy G343.
• Alcoholic cardiomyopathy G555.
• Cardiomyopathy NOS G55z.
• Valvular heart disease G54z5
• Echo showing LVSD G585F

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SCIMP Read Codes

• Many!
• Confusing!
• Need to agree codes to be used to ensure
  consistency
• Suggested codes
• LVD G581 LVSD G5yy9
• (With others agreed when producing protocol)

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Registers

• Construction is time consuming
• Needs everyone in the practice to agree,
  implement and maintain process
• We can help
• ?benefits for practice

13
GMS

• Links practice income to achievement of evidence
  based and measurable clinical targets
• Of a maximum of 550 pts available in the clinical
  domain, 356 can be gained from patients with CHD
  and LVD, hypertension, stoke and diabetes

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GMS

• Heart Failure is only included for points if
  the patient is coded as having CHD and LVD
• - Register for patients with CHD and LVD 4
  points
• - CHD and LVD confirmed by ECHO 6 points
• - CHD and LVD patients treated with ACE/ARB 10
  points

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GMS

• Many patients will have co-morbidities and link
  with other chronic disease registers
• However there are some patients with heart
  failure who may not (e.g. cardiomyopathies of
  unknown origin)

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Partnership working

• We can provide
• Resources for audit
• Heart Failure nurses available for advice and
  support

• We need you to
• Champion the project
• Id pilot sites and practice nurses pharmacists
  and others who can help

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Partnership working

• If you would like to get involved please contact
  John Carson
• 01355 584624
• or any member of the HF team

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Outcomes for patients

• Earlier detection of condition
• Good control to minimise effects of condition and
  reduce complications
• More effective medicine management
• Reduction in the number of reactive crises
• Promote independence
• Promote and extend QoL

19
Outcomes for us

• Well managed patients
• Increased knowledge and confidence in HF
  management via partnership working
• Reduction in patient appointments
• Well placed if GMS expand HF parameters within
  the QoF

20
Thank You

• Questions?
• HF Primary Care Pilot Project 01355 584624